=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063284347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE AND INSPIRATION PSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2023
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16501D NORTHCROSS DR # 121
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-5081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-325-9464
-----------------------------------------------------
Fax | 704-275-1833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 LANGHORNE DR
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28120-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-517-7130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGICAL ASSOCIATE
-----------------------------------------------------
Name | JILL ELIZABETH PRATT
-----------------------------------------------------
Credential | LPA
-----------------------------------------------------
Telephone | 704-325-9464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------