Healthcare Provider Details

I. General information

NPI: 1548043474
Provider Name (Legal Business Name): HOPE AND HEALING THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 NEWTOWN RD STE B-2
VIRGINIA BEACH VA
23462-2412
US

IV. Provider business mailing address

154 NEWTOWN RD STE B-2
VIRGINIA BEACH VA
23462-2412
US

V. Phone/Fax

Practice location:
  • Phone: 757-777-4956
  • Fax:
Mailing address:
  • Phone: 757-777-4956
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATISHA MOORE
Title or Position: CEO
Credential: LPC,CSAC
Phone: 757-777-4956