Provider Demographics
NPI:1255029138
Name:INSTILLING HOPE PROFESSIONAL COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:INSTILLING HOPE PROFESSIONAL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-200-1538
Mailing Address - Street 1:1301 SIOUX ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3259
Mailing Address - Country:US
Mailing Address - Phone:334-405-7284
Mailing Address - Fax:256-207-4720
Practice Address - Street 1:256 HONEYSUCKLE RD STE 24
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1119
Practice Address - Country:US
Practice Address - Phone:334-405-7284
Practice Address - Fax:256-207-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty