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General NPI Number Information
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NPI Number | 1356858997
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Entity Type | Organization
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Legal Business Name | HOPE REBORN COUNSELING, PLLC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 2816 WILLA DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-359-1065
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Fax | 269-985-0247
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Provider Business Mailing Address
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Address Line | 2816 WILLA DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2555
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Country | US
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Telephone | 269-359-1065
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. NADINE RENEE FISH
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Credential | LMSW, CAADC
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Telephone | 269-359-1065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090473
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License Number State | MI
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