=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427468206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE ABOUNDS CHRISTIAN COUNSELING SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2014
-----------------------------------------------------
Last Update Date | 05/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 HUGH BLACK RD
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-7700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-454-3549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 SAINT CLAIR ST
-----------------------------------------------------
City | LATROBE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15650-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-454-3549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LCSW
-----------------------------------------------------
Name | MRS. LORIN A ZIMMERMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 724-454-3549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016582
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------