Healthcare Provider Details

I. General information

NPI: 1306907092
Provider Name (Legal Business Name): FAITH BASED COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S BROAD ST SUITE 234
LANCASTER OH
43130
US

IV. Provider business mailing address

123 S BROAD ST SUITE 234
LANCASTER OH
43130
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-8716
  • Fax: 740-653-9252
Mailing address:
  • Phone: 740-654-8716
  • Fax: 740-653-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SONIA E THOMAS
Title or Position: OFFICE MGR BILLING
Credential:
Phone: 740-654-8716