Provider Demographics
NPI:1598170672
Name:HOPE RENEWED COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:HOPE RENEWED COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-416-2280
Mailing Address - Street 1:631 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2833
Mailing Address - Country:US
Mailing Address - Phone:617-416-2280
Mailing Address - Fax:
Practice Address - Street 1:631 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067
Practice Address - Country:US
Practice Address - Phone:617-416-2280
Practice Address - Fax:781-806-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116260251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1336498138OtherNPI TYPE 1