Healthcare Provider Details

I. General information

NPI: 1346936127
Provider Name (Legal Business Name): WAVES OF HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SMILEY RD
GLEN CAMPBELL PA
15742-8611
US

IV. Provider business mailing address

80 SMILEY RD
GLEN CAMPBELL PA
15742-8611
US

V. Phone/Fax

Practice location:
  • Phone: 814-935-9019
  • Fax:
Mailing address:
  • Phone: 814-935-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GINA WILSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 814-935-9019