MEDICARE: CIRCLE OF HOPE, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1871125435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE OF HOPE, LLC

Provider Business Mailing Address
First Line	:	818 SEMINOLE DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4131
Country	:	US
Telephone Number	:	757-334-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 SEMINOLE DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4131
Country	:	US
Telephone Number	:	757-334-0773
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. STACEY ARLEEN MANLEY
Credential	:	MA, LMHP-R
Telephone Number	:	757-334-0773

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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