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General NPI Number Information
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NPI Number | 1871029546
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Entity Type | Organization
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Legal Business Name | EVERLASTING HOPE PLLC
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 2901 S ETHEL ST
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City | DETROIT
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State | MI
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Zip | 48217-1531
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Country | US
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Telephone | 313-775-6335
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 S ETHEL ST
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City | DETROIT
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State | MI
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Zip | 48217-1531
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Country | US
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Telephone | 313-775-6335
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | CHERYL ANN JACKSON
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Credential | LMSW, MSW, MBA
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Telephone | 313-775-6335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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Taxonomy #6
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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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