Healthcare Provider Details

I. General information

NPI: 1447834387
Provider Name (Legal Business Name): HOPE RESTORED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 STAPLES MILL RD
HENRICO VA
23228-2718
US

IV. Provider business mailing address

8655 STAPLES MILL RD
HENRICO VA
23228-2718
US

V. Phone/Fax

Practice location:
  • Phone: 804-982-6574
  • Fax: 804-215-3218
Mailing address:
  • Phone: 804-982-6574
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMI BALLAY WILLIAMS
Title or Position: EXCUTIVE DIRECTOR
Credential: LPC
Phone: 804-252-9391