=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942786793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVERING HOPE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2018
-----------------------------------------------------
Last Update Date | 07/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9480 HIGHWAY 805
-----------------------------------------------------
City | JENKINS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41537-8182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-639-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 983
-----------------------------------------------------
City | CLINTWOOD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24228-0983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-639-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/LEAD CLINICIAN
-----------------------------------------------------
Name | MR. ANDREW JUSTIN BAKER ROSE
-----------------------------------------------------
Credential | TCADC
-----------------------------------------------------
Telephone | 276-639-0077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------