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General NPI Number Information
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NPI Number | 1477952364
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Entity Type | Organization
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Legal Business Name | HOPE AND HEALING CENTER, LLC
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 6015 MORROW ST E SUITE114
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2121
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Country | US
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Telephone | 800-896-6105
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Fax | 904-637-4716
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Provider Business Mailing Address
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Address Line | 4411 SUNBEAM RD # 56918 SUITE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32257-7525
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Country | US
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Telephone | 800-896-6105
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Fax | 904-637-4716
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | SELMA ZAKOMAC BACEVAC
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Credential | LMHC
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Telephone | 800-896-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12197
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License Number State | FL
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