Healthcare Provider Details

I. General information

NPI: 1306021068
Provider Name (Legal Business Name): HOPE IN THE CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N. MAIN STREET, SUITE 2
KENANSVILLE NC
28349-9019
US

IV. Provider business mailing address

PO BOX 1576
ROSEBORO NC
28382-1576
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-6244
  • Fax:
Mailing address:
  • Phone: 910-916-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. SHELTON JAMES PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-916-3929