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General NPI Number Information
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NPI Number | 1992499123
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Entity Type | Organization
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Legal Business Name | MENDED HOPE THERAPY, PLLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 960 CORPORATE DR STE 201
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-8560
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Country | US
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Telephone | 919-228-9098
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Fax |
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Provider Business Mailing Address
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Address Line | 960 CORPORATE DR STE 201
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-8560
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Country | US
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Telephone | 919-228-9098
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/BUSINESS OWNER
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Name | DR. CHARLES JARDIN
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Credential | PHD, MDIV
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Telephone | 919-672-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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