Provider Demographics
NPI:1689031122
Name:HOPESPRING CHILD & FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:HOPESPRING CHILD & FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MI-KYONG
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCPC
Authorized Official - Phone:410-241-2520
Mailing Address - Street 1:24981 WATERDOCK DR
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5607
Mailing Address - Country:US
Mailing Address - Phone:410-241-2520
Mailing Address - Fax:410-442-1075
Practice Address - Street 1:1497 CHAIN BRIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5728
Practice Address - Country:US
Practice Address - Phone:410-241-2520
Practice Address - Fax:410-442-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty