Healthcare Provider Details

I. General information

NPI: 1831947530
Provider Name (Legal Business Name): HOPE & HEALING COUNSELING WEST VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRYN MAWR CT
FALLING WATERS WV
25419
US

IV. Provider business mailing address

504 EMILY DR
CLARKSBURG WV
26301-5507
US

V. Phone/Fax

Practice location:
  • Phone: 855-453-6611
  • Fax: 973-200-8137
Mailing address:
  • Phone: 855-453-6611
  • Fax: 973-200-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LENA CHAMBERLAIN
Title or Position: OWNER
Credential:
Phone: 201-665-3066