Provider Demographics
NPI:1578296521
Name:INTENTIONAL HOPE AND HEALING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INTENTIONAL HOPE AND HEALING COUNSELING SERVICES, LLC
Other - Org Name:INTENTIONAL HOPE AND HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:571-306-1216
Mailing Address - Street 1:1216 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3026
Mailing Address - Country:US
Mailing Address - Phone:571-306-1216
Mailing Address - Fax:
Practice Address - Street 1:1216 GRANADA ST
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3026
Practice Address - Country:US
Practice Address - Phone:571-306-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444880400Medicaid