Provider Demographics
NPI:1013507862
Name:FOREVER HOPE, PLLC
Entity Type:Organization
Organization Name:FOREVER HOPE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D'ANDREA
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-793-5718
Mailing Address - Street 1:PO BOX 25653
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5653
Mailing Address - Country:US
Mailing Address - Phone:336-793-5718
Mailing Address - Fax:336-790-6770
Practice Address - Street 1:3000 BETHESDA PL STE 201
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3324
Practice Address - Country:US
Practice Address - Phone:336-793-5718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568941326OtherNPI
NC1790182251OtherNPI