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General NPI Number Information
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NPI Number | 1003053034
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Entity Type | Organization
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Legal Business Name | THE HOPE CENTER
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 206 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7154
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Country | US
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Telephone | 601-264-0890
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Fax | 601-261-0471
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Provider Business Mailing Address
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Address Line | PO BOX 17918
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City | HATTIESBURG
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State | MS
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Zip | 39404-7918
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Country | US
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Telephone | 601-264-0890
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Fax | 601-261-0471
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. BEVERLY SMALLWOOD
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Credential | PH.D.
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Telephone | 601-264-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 22268
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 22268
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License Number State | MS
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