MEDICARE: H3 - HOPE, HEALTH & HEALING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316559420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H3 - HOPE, HEALTH & HEALING PLLC

Provider Business Mailing Address
First Line	:	5503 NIGHTINGALE CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-9499
Country	:	US
Telephone Number	:	336-500-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	5503 NIGHTINGALE CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-9499
Country	:	US
Telephone Number	:	336-500-2840
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LESLIE R GONZALEZ
Credential	:	LCSW
Telephone Number	:	336-500-2840

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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