Provider Demographics
NPI:1790210805
Name:ACENTER FOR HOPE AND CHANGE
Entity Type:Organization
Organization Name:ACENTER FOR HOPE AND CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMPA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-990-8276
Mailing Address - Street 1:6811 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-9423
Mailing Address - Country:US
Mailing Address - Phone:318-990-8276
Mailing Address - Fax:
Practice Address - Street 1:6811 SAGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-9423
Practice Address - Country:US
Practice Address - Phone:318-990-8276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health