Provider Demographics
NPI:1245730001
Name:TRICORD HOPE LLC
Entity type:Organization
Organization Name:TRICORD HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-658-9012
Mailing Address - Street 1:2320 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-2626
Mailing Address - Country:US
Mailing Address - Phone:770-658-9012
Mailing Address - Fax:
Practice Address - Street 1:141 HIGHWAY 142
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-4857
Practice Address - Country:US
Practice Address - Phone:770-658-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty