MEDICARE: HOPE THERAPY AND WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1457819369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE THERAPY AND WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	904 PRINCESS ANNE ST STE 204
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5801
Country	:	US
Telephone Number	:	703-229-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 BRADDOCK RD STE 220
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-1002
Country	:	US
Telephone Number	:	571-748-5999
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JENNIFER CHELLIS
Credential	:
Telephone Number	:	703-229-6121

Provider Enumeration Date	:	03/10/2019
Last Update Date	:	05/02/2023

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