Provider Demographics
NPI:1750621488
Name:HOPE FOR LIFE
Entity type:Organization
Organization Name:HOPE FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, LPCC, NCC
Authorized Official - Phone:276-639-5710
Mailing Address - Street 1:235 S LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2039
Mailing Address - Country:US
Mailing Address - Phone:276-639-5710
Mailing Address - Fax:
Practice Address - Street 1:235 S LAKEWOOD ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2039
Practice Address - Country:US
Practice Address - Phone:276-639-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1402OtherKENTUCKY LICENSING BOARD
VA0701005355OtherVIRGINIA LICENSING BOARD