Healthcare Provider Details

I. General information

NPI: 1235312661
Provider Name (Legal Business Name): NEW HOPE RESIDENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WESTLAKE RD SUITE 201
FAYETTEVILLE NC
28314-4863
US

IV. Provider business mailing address

235 WESTLAKE RD SUITE 201
FAYETTEVILLE NC
28314-4863
US

V. Phone/Fax

Practice location:
  • Phone: 910-229-1473
  • Fax: 910-864-4700
Mailing address:
  • Phone: 910-229-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HAZEL CASSANDRA BYRD
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 910-229-1473