MEDICARE: HOPE, LOVE, AND DREAM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084P0015X	Psychosomatic Medicine Physician
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YM0800X	Mental Health Counselor
5	101YP2500X	Professional Counselor
6	103TC0700X	Clinical Psychologist
7	103TC1900X	Counseling Psychologist
8	104100000X	Social Worker
9	1041C0700X	Clinical Social Worker
10	106H00000X	Marriage & Family Therapist
11	163WP0808X	Psychiatric/Mental Health Registered Nurse
12	164W00000X	Licensed Practical Nurse
13	171M00000X	Case Manager/Care Coordinator
14	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073128716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE, LOVE, AND DREAM, INC

Provider Business Mailing Address
First Line	:	1491 POLARIS PKWY STE 216
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 GROVE HILL DRIVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240
Country	:	US
Telephone Number	:	740-526-1071
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	DR. DOMONIQUE RICE
Credential	:	PHD, IMFT-S
Telephone Number	:	740-526-1071

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/05/2024

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Directions to “HOPE, LOVE, AND DREAM, INC ” Practice Location

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