Provider Demographics
NPI:1932897642
Name:MIND OF HOPE PSYCHOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:MIND OF HOPE PSYCHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-441-7080
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:NC
Mailing Address - Zip Code:28478-0211
Mailing Address - Country:US
Mailing Address - Phone:910-441-7080
Mailing Address - Fax:910-552-5006
Practice Address - Street 1:7190 NC HWY 11
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:NC
Practice Address - Zip Code:28478-7062
Practice Address - Country:US
Practice Address - Phone:910-441-7080
Practice Address - Fax:910-441-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty