Provider Demographics
NPI:1740877638
Name:HOPE REVISITED COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:HOPE REVISITED COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-821-1035
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0532
Mailing Address - Country:US
Mailing Address - Phone:509-821-1035
Mailing Address - Fax:
Practice Address - Street 1:500 W ROBERT BUSH DR STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586-9075
Practice Address - Country:US
Practice Address - Phone:360-209-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty