Healthcare Provider Details

I. General information

NPI: 1992015077
Provider Name (Legal Business Name): FAITH HOPE AND LOVE COMMUNITY ENRICHMENT MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N MARIETTA ST
GASTONIA NC
28052-2338
US

IV. Provider business mailing address

602 N MARIETTA ST
GASTONIA NC
28052-2338
US

V. Phone/Fax

Practice location:
  • Phone: 704-840-5527
  • Fax:
Mailing address:
  • Phone: 704-840-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MOSES COLBERT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 704-840-5527