Provider Demographics
NPI:1306384144
Name:FOUNTAIN OF HOPE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:FOUNTAIN OF HOPE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-423-3600
Mailing Address - Street 1:4108 OLD VIRGINIA RD
Mailing Address - Street 2:CHESAPEAKE
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1624
Mailing Address - Country:US
Mailing Address - Phone:404-423-3600
Mailing Address - Fax:
Practice Address - Street 1:100 BRIDGE ST
Practice Address - Street 2:SUITE C2
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4067
Practice Address - Country:US
Practice Address - Phone:404-423-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty