Healthcare Provider Details

I. General information

NPI: 1962045294
Provider Name (Legal Business Name): HOUSE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 SUNRISE DR
LINCOLNTON GA
30817-4249
US

IV. Provider business mailing address

296 SUNRISE DR
LINCOLNTON GA
30817-4249
US

V. Phone/Fax

Practice location:
  • Phone: 706-990-0595
  • Fax: 706-359-3142
Mailing address:
  • Phone: 706-990-0595
  • Fax: 706-990-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. HOPE SHANELL BEARD
Title or Position: OWNER
Credential: LPC
Phone: 706-990-0595