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General NPI Number Information
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NPI Number | 1740877638
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Entity Type | Organization
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Legal Business Name | HOPE REVISITED COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 500 W ROBERT BUSH DR STE 3
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City | SOUTH BEND
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State | WA
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Zip | 98586-9075
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Country | US
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Telephone | 360-209-3240
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 532
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City | SOUTH BEND
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State | WA
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Zip | 98586-0532
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Country | US
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Telephone | 509-821-1035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GINA RENEE MILES
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Credential | LICSW
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Telephone | 509-821-1035
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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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