Provider Demographics
NPI:1477952364
Name:HOPE AND HEALING CENTER, LLC
Entity type:Organization
Organization Name:HOPE AND HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:ZAKOMAC
Authorized Official - Last Name:BACEVAC
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:800-896-6105
Mailing Address - Street 1:4411 SUNBEAM RD # 56918
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-7525
Mailing Address - Country:US
Mailing Address - Phone:800-896-6105
Mailing Address - Fax:904-637-4716
Practice Address - Street 1:6015 MORROW ST E
Practice Address - Street 2:SUITE114
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2121
Practice Address - Country:US
Practice Address - Phone:800-896-6105
Practice Address - Fax:904-637-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010484600Medicaid