MEDICARE: VISIONS OF HOPE COUNSELING AND SOCIAL SERVICES LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144098708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONS OF HOPE COUNSELING AND SOCIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	3117 SPRING GLEN RD STE 403
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-662-7919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 SPRING GLEN RD STE 403
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-662-7919
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORNISHIA SIMMONS
Credential	:	MHC
Telephone Number	:	904-662-7919

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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