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General NPI Number Information
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NPI Number | 1134584626
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Entity Type | Organization
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Legal Business Name | ONE LOVE COMMUNITY PROGRAM INC.
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 5701 EXECUTIVE CENTER DR SUITE 350
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City | CHARLOTTE
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State | NC
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Zip | 28212-8862
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Country | US
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Telephone | 704-567-9800
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Fax | 866-577-8514
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Provider Business Mailing Address
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Address Line | 5701 EXECUTIVE CENTER DR SUITE 350
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City | CHARLOTTE
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State | NC
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Zip | 28212-8862
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Country | US
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Telephone | 704-567-9800
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Fax | 866-577-8514
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ALICIA SPIVEY JOHNSON
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Credential |
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Telephone | 704-307-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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