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General NPI Number Information
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NPI Number | 1447164744
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Entity Type | Organization
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Legal Business Name | HOPE, HEALING, & WELLNESS THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 37 COURT ST
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City | JASPER
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State | GA
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Zip | 30143-1542
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Country | US
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Telephone | 678-230-5164
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Fax | 678-203-3724
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Provider Business Mailing Address
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Address Line | 306 CALUSA PL
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City | BALL GROUND
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State | GA
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Zip | 30107-2998
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Country | US
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Telephone | 678-230-5164
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Fax | 678-203-3724
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Authorized Official
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Title or Position | OWNER
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Name | LISA K BROUSSARD
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Credential | LCSW
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Telephone | 678-230-5164
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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 | NULL
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