Provider Demographics
NPI:1013493717
Name:VISION OF PROMISE LLC
Entity Type:Organization
Organization Name:VISION OF PROMISE LLC
Other - Org Name:VISION OF PROMISE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER AND CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DESHARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, MFT-ASSOCIATE
Authorized Official - Phone:502-532-1922
Mailing Address - Street 1:2312 S PRESTON ST UNIT 17707
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-5029
Mailing Address - Country:US
Mailing Address - Phone:502-532-1922
Mailing Address - Fax:
Practice Address - Street 1:2312 S PRESTON ST UNIT 17707
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-5029
Practice Address - Country:US
Practice Address - Phone:502-532-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
KY106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty