Healthcare Provider Details

I. General information

NPI: 1871176529
Provider Name (Legal Business Name): HOPE RESTORATIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 HERITAGE DRIVE SUITE 102
WAKE FOREST NC
27587
US

IV. Provider business mailing address

20 SUTHERLAND DR
FRANKLINTON NC
27525-6614
US

V. Phone/Fax

Practice location:
  • Phone: 919-438-2167
  • Fax:
Mailing address:
  • Phone: 508-762-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: VANESSA WILDER
Title or Position: OWNER
Credential: LCMHCA
Phone: 919-438-2167