Provider Demographics
NPI:1578885570
Name:BEACON OF HOPE COUNSELING, PLLC
Entity Type:Organization
Organization Name:BEACON OF HOPE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-599-6806
Mailing Address - Street 1:2632 CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1806
Mailing Address - Country:US
Mailing Address - Phone:910-599-6806
Mailing Address - Fax:
Practice Address - Street 1:2632 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1806
Practice Address - Country:US
Practice Address - Phone:910-599-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103836Medicaid