Provider Demographics
NPI:1588081541
Name:JOURNEY TO HOPE, LLC
Entity type:Organization
Organization Name:JOURNEY TO HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:678-662-2962
Mailing Address - Street 1:7841 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3872
Mailing Address - Country:US
Mailing Address - Phone:678-662-2962
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD
Practice Address - Street 2:SUITE E-1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5023
Practice Address - Country:US
Practice Address - Phone:470-377-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006959251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811318454OtherNPI TYPE 1