Healthcare Provider Details

I. General information

NPI: 1801075403
Provider Name (Legal Business Name): CIRCLE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MOUNTAIN AVE SW
ROANOKE VA
24016-4044
US

IV. Provider business mailing address

325 MOUNTAIN AVE SW
ROANOKE VA
24016-4044
US

V. Phone/Fax

Practice location:
  • Phone: 540-206-2330
  • Fax: 540-206-2330
Mailing address:
  • Phone: 540-206-2330
  • Fax: 540-206-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710001076
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003710
License Number StateVA

VIII. Authorized Official

Name: MS. SHARON KAY TOLIVER-HARDY
Title or Position: DIRECTOR
Credential: MASTERS DEGREE
Phone: 540-206-2330