Healthcare Provider Details

I. General information

NPI: 1447164744
Provider Name (Legal Business Name): HOPE, HEALING, & WELLNESS THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 COURT ST
JASPER GA
30143-1542
US

IV. Provider business mailing address

306 CALUSA PL
BALL GROUND GA
30107-2998
US

V. Phone/Fax

Practice location:
  • Phone: 678-230-5164
  • Fax: 678-203-3724
Mailing address:
  • Phone: 678-230-5164
  • Fax: 678-203-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA K BROUSSARD
Title or Position: OWNER
Credential: LCSW
Phone: 678-230-5164