MEDICARE: HOPE FOR FAMILIES AND COMMUNITY SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103TC2200X	Clinical Child & Adolescent Psychologist	703	AL
4	2084P0800X	Psychiatry Physician	DO 421	AL

General Provider Information

NPI Number	:	1093984148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE FOR FAMILIES AND COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 226
Second Line	:
City	:	NOTASULGA
State	:	AL
Zip	:	36866-0226
Country	:	US
Telephone Number	:	334-725-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 MIMOSA AVE
Second Line	:
City	:	UNION SPRINGS
State	:	AL
Zip	:	36089-2127
Country	:	US
Telephone Number	:	334-318-5108
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LULA JONES BRIDGES
Credential	:	MS, LBSW
Telephone Number	:	334-318-5108

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/18/2009

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