Provider Demographics
NPI:1619607926
Name:HOPE SOURCE COUNSELING
Entity Type:Organization
Organization Name:HOPE SOURCE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOBACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-774-5017
Mailing Address - Street 1:14701 COLLINGTON TURN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1584
Mailing Address - Country:US
Mailing Address - Phone:804-774-5017
Mailing Address - Fax:
Practice Address - Street 1:14701 COLLINGTON TURN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1584
Practice Address - Country:US
Practice Address - Phone:804-774-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty