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General NPI Number Information
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NPI Number | 1104057488
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Entity Type | Organization
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Legal Business Name | GENERATIONS OF HOPE
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 656 LARKSPUR DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-6955
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Country | US
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Telephone | 910-822-4071
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Fax | 910-488-1122
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Provider Business Mailing Address
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Address Line | 656 LARKSPUR DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-6955
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Country | US
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Telephone | 910-822-4071
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Fax | 910-488-1122
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Authorized Official
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Title or Position | CONSULTANT
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Name | MRS. BIANCA P GANTT
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Credential | LCSW
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Telephone | 910-822-4071
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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 |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NC
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