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General NPI Number Information
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NPI Number | 1063898476
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Entity Type | Organization
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Legal Business Name | HOPE 4 TOMORROW LLC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 2422 E WASHINGTON ST SUITE 107
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4478
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Country | US
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Telephone | 309-310-9621
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Fax | 309-454-6501
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Provider Business Mailing Address
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Address Line | 2422 E WASHINGTON ST SUITE 107
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4478
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Country | US
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Telephone | 309-310-9621
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Fax | 309-454-6501
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Authorized Official
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Title or Position | OWNER
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Name | ROXXI M DAVIS
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Credential | LCSW
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Telephone | 309-310-9621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.015543
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License Number State | IL
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