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General NPI Number Information
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NPI Number | 1356930416
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Entity Type | Organization
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Legal Business Name | PROMISE OF HOPE COUNSELING INC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 2989 W STATE ROAD 434 STE 100
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City | LONGWOOD
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State | FL
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Zip | 32779-4898
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Country | US
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Telephone | 407-786-1913
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Fax | 407-960-2636
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Provider Business Mailing Address
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Address Line | 2989 W STATE ROAD 434 STE 100
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City | LONGWOOD
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State | FL
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Zip | 32779-4898
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Country | US
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Telephone | 407-786-1913
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Fax | 407-960-2636
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA LEANNE SHAW
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Credential | BS
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Telephone | 407-786-1913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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