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General NPI Number Information
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NPI Number | 1720766272
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Entity Type | Organization
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Legal Business Name | HOPEFUL HORIZON WELLNESS LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 3 3RD ST STE 20
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1370
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Country | US
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Telephone | 732-749-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 3495 US HWY 1 STE 34 #1166 #1166
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City | PRINCETON
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State | NJ
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Zip | 08540
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Country | US
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Telephone | 732-749-4267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARISSA NICKSON
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Credential | LCSW
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Telephone | 732-749-4267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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