Provider Demographics
NPI:1811289952
Name:HOPEWELL FAMILY COUNSELING AND INDIVIDUAL THERAPY SERVICES
Entity type:Organization
Organization Name:HOPEWELL FAMILY COUNSELING AND INDIVIDUAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:KIRT
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-344-4406
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 201-B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2573
Mailing Address - Country:US
Mailing Address - Phone:757-772-9566
Mailing Address - Fax:757-772-0565
Practice Address - Street 1:610 THIMBLE SHOALS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2573
Practice Address - Country:US
Practice Address - Phone:757-772-9566
Practice Address - Fax:757-772-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007351251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health