=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154806057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOURNEY 4 HOPE COUNSELING CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 EVANS MILL DR STE 306
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30157-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-500-9177
-----------------------------------------------------
Fax | 770-783-6628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 JESSEL LN
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-5901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAROL HUFF
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 404-316-3352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------