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General NPI Number Information
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NPI Number | 1760293856
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Entity Type | Organization
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Legal Business Name | HOPE AHEAD LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 809 W DETWEILLER DR STE 810
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City | PEORIA
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State | IL
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Zip | 61615-2140
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Country | US
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Telephone | 309-264-9517
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 W STONEHENGE CT
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City | PEORIA
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State | IL
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Zip | 61615-7481
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Country | US
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Telephone | 309-264-9517
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | SANDRA CROSS
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Credential | LCSW
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Telephone | 309-264-9517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 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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