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General NPI Number Information
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NPI Number | 1790036820
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Entity Type | Organization
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Legal Business Name | BRANCHES OF HOPE, LLC MENTAL HEALTH SUPPORT
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 20 WALNUT ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2724
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Country | US
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Telephone | 276-632-3210
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Fax | 276-632-3213
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Provider Business Mailing Address
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Address Line | 58 W CHURCH ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-6210
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Country | US
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Telephone | 276-632-3210
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Fax | 276-632-3213
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Authorized Official
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Title or Position | OWNER-LICENSEE
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Name | MR. KERRY GLENN SMITH
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Credential | PRESIDENT
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Telephone | 276-632-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | VA
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