Healthcare Provider Details

I. General information

NPI: 1508136888
Provider Name (Legal Business Name): HOPSCOTCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 S BERKELEY LAKE RD
NORCROSS GA
30071-1660
US

IV. Provider business mailing address

4530 S BERKELEY LAKE RD
NORCROSS GA
30071-1660
US

V. Phone/Fax

Practice location:
  • Phone: 770-446-5642
  • Fax: 770-446-5643
Mailing address:
  • Phone: 770-446-5642
  • Fax: 770-446-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSA MCDANIEL ASHE
Title or Position: CEO
Credential: PHD
Phone: 770-446-5642