=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801410600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCENDING HOPE COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2020
-----------------------------------------------------
Last Update Date | 06/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 S ELM EUGENE ST STE 3110
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27406-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-920-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 WEBSTER RD APT B
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27406-5861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-707-8535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHELVEY JEAN WALLACE
-----------------------------------------------------
Credential | MSW, LCSW, LCAS
-----------------------------------------------------
Telephone | 336-707-8535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------