Provider Demographics
NPI:1134584626
Name:ONE LOVE COMMUNITY PROGRAM INC.
Entity type:Organization
Organization Name:ONE LOVE COMMUNITY PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:SPIVEY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-307-7073
Mailing Address - Street 1:5701 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8862
Mailing Address - Country:US
Mailing Address - Phone:704-567-9800
Mailing Address - Fax:866-577-8514
Practice Address - Street 1:5701 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 350
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8862
Practice Address - Country:US
Practice Address - Phone:704-567-9800
Practice Address - Fax:866-577-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty