34D2157543 CLIA NUMBER - HOPE WELLNESS MANAGEMENT PLLC

Laboratory Demographics

CLIA Number: 34D2157543

Facility Name: HOPE WELLNESS MANAGEMENT PLLC

Facility Address:
412 SOUTH SUTHERLAND AVENUE
MONROE, NC
ZIP 28112
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Facility Phone Number: 704 568-9133

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871026567

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	34D2157543
LAB Type	Physician Office
Facility Name	HOPE WELLNESS MANAGEMENT PLLC
Street	412 SOUTH SUTHERLAND AVENUE
City	MONROE
State	NC
ZIP	28112
Phone	704 568-9133
CertificateType	4
CertificateEffectiveDate	11/7/2022
CertificateExpirationDate	11/6/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024