MEDICARE: BEACON OF HOPE COUNSELING, 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	101YP2500X	Professional Counselor	6876	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578885570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON OF HOPE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2632 CAROLINA BEACH RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-1806
Country	:	US
Telephone Number	:	910-599-6806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 CAROLINA BEACH RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-1806
Country	:	US
Telephone Number	:	910-599-6806
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	KELLY HARDEE
Credential	:	LPC
Telephone Number	:	910-599-6806

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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