Healthcare Provider Details

I. General information

NPI: 1427681691
Provider Name (Legal Business Name): FAITH HORIZON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 S MIAMI BLVD STE 232
DURHAM NC
27703-4900
US

IV. Provider business mailing address

207 RONDELAY DR
DURHAM NC
27703-9701
US

V. Phone/Fax

Practice location:
  • Phone: 919-702-3652
  • Fax:
Mailing address:
  • Phone: 919-702-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN WINSTON SMITH JR.
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 919-702-3652