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General NPI Number Information
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NPI Number | 1548988207
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Entity Type | Organization
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Legal Business Name | HOPE'S HALO THERAPY COLLECTIVE, PLLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 1010 W VILLAS DR
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City | VICKSBURG
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State | MI
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Zip | 49097-9626
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Country | US
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Telephone | 269-760-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 417 FOREST ST # 532
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City | KALAMAZOO
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State | MI
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Zip | 49001-2747
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Country | US
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Telephone | 269-760-1011
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MISS AZMEN HOPE WILLIAMS
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Credential | LMSW
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Telephone | 269-760-1011
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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 |
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