=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063929354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWER OF HOPE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2018
-----------------------------------------------------
Last Update Date | 01/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 MAIN ST
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-4730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-733-0816
-----------------------------------------------------
Fax | 203-730-8807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 MAIN ST
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-4730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-733-0816
-----------------------------------------------------
Fax | 203-730-8807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEANNE BIELAWA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 203-733-0816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 003240
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------