Provider Demographics
NPI:1235240227
Name:COMMUNITY HOPE CHRISTIAN COUNSELING & MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:COMMUNITY HOPE CHRISTIAN COUNSELING & MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-225-8220
Mailing Address - Street 1:6728 VINING RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9784
Mailing Address - Country:US
Mailing Address - Phone:616-225-8220
Mailing Address - Fax:616-225-8226
Practice Address - Street 1:6728 VINING RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9784
Practice Address - Country:US
Practice Address - Phone:616-225-8220
Practice Address - Fax:616-225-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI68010812291041C0700X
MI68010668411041C0700X
MI68010875741041C0700X
MI68010869701041C0700X
MI68020797411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800E910320OtherBC/BSM