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General NPI Number Information
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NPI Number | 1720982804
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Entity Type | Organization
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Legal Business Name | SEEDS OF HOPE COUNSELING, LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 2000 RED ROBIN DR N
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City | XENIA
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State | OH
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Zip | 45385-9915
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Country | US
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Telephone | 937-718-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 RED ROBIN DR N
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City | XENIA
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State | OH
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Zip | 45385-9915
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Country | US
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Telephone | 937-718-3317
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTHCOUNSELOR
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Name | NICOLE WAGSTROM
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Credential | LPCC
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Telephone | 937-718-3317
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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 |
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License Number State | NULL
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