Provider Demographics
NPI:1508392895
Name:THE HOPE CENTER OF CARMODY HILLS
Entity Type:Organization
Organization Name:THE HOPE CENTER OF CARMODY HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK LEIVA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, NCC, LPC, LCPC
Authorized Official - Phone:240-719-2699
Mailing Address - Street 1:6501 SEAT PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-6016
Mailing Address - Country:US
Mailing Address - Phone:240-719-2699
Mailing Address - Fax:
Practice Address - Street 1:6501 SEAT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-6016
Practice Address - Country:US
Practice Address - Phone:240-719-2699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3332302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization