Healthcare Provider Details

I. General information

NPI: 1790980779
Provider Name (Legal Business Name): JEREMIAH HOPES LCMHCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13534 PLAZA ROAD EXT
CHARLOTTE NC
28215-8921
US

IV. Provider business mailing address

12420 OAKTON HUNT DR
CHARLOTTE NC
28262-1525
US

V. Phone/Fax

Practice location:
  • Phone: 704-724-9727
  • Fax:
Mailing address:
  • Phone: 704-724-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS5005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: