Organization
IC HOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IDA M NELSON CSAC (CO-OWNER)
(804) 363-8964
Entity
Organization
Contact information
Practice address
501 E FRANKLIN ST, SUITE 717, RICHMOND, VA 23219-2322
(804) 237-9420
Mailing address
PO BOX 793, MECHANICSVILLE, VA 23111-0793
(804) 363-8964
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102443
VA
251B00000X
Case Management Agency
0710102443
VA
251S00000X
Community/Behavioral Health Agency
0710102443
VA
324500000X
Substance Abuse Rehabilitation Facility
Primary
0710102443
VA
Other
Enumeration date
02/09/2012
Last updated
11/06/2012
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