Provider Demographics
NPI:1194372649
Name:NURTURING HOPE LLC
Entity Type:Organization
Organization Name:NURTURING HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ALC
Authorized Official - Phone:256-276-9424
Mailing Address - Street 1:790 COOSA COUNTY ROAD 86
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-2005
Mailing Address - Country:US
Mailing Address - Phone:256-276-9424
Mailing Address - Fax:
Practice Address - Street 1:790 COOSA COUNTY ROAD 86
Practice Address - Street 2:
Practice Address - City:GOODWATER
Practice Address - State:AL
Practice Address - Zip Code:35072-2005
Practice Address - Country:US
Practice Address - Phone:256-276-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL231582Medicaid