Provider Demographics
NPI:1306196779
Name:HARBOR OF HOPE COUNSELING, LLC
Entity Type:Organization
Organization Name:HARBOR OF HOPE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-764-6444
Mailing Address - Street 1:62 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-5741
Mailing Address - Country:US
Mailing Address - Phone:570-764-6444
Mailing Address - Fax:570-759-1935
Practice Address - Street 1:62 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-5741
Practice Address - Country:US
Practice Address - Phone:570-764-6444
Practice Address - Fax:570-759-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty