Provider Demographics
NPI:1831662832
Name:SEEDS OF HOPE COUNSELING, PLLC
Entity Type:Organization
Organization Name:SEEDS OF HOPE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:FULCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-519-2224
Mailing Address - Street 1:300 N MCCOMBS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2165
Mailing Address - Country:US
Mailing Address - Phone:731-281-8070
Mailing Address - Fax:731-281-8070
Practice Address - Street 1:300 N MCCOMBS ST STE 1
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2165
Practice Address - Country:US
Practice Address - Phone:731-281-8070
Practice Address - Fax:731-284-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046634Medicaid