Healthcare Provider Details

I. General information

NPI: 1619861929
Provider Name (Legal Business Name): FAITH LORRIE MEBANE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W GODFREY AVE
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

2301 WOODWARD ST APT G19
PHILADELPHIA PA
19115-5151
US

V. Phone/Fax

Practice location:
  • Phone: 609-836-0705
  • Fax:
Mailing address:
  • Phone: 267-349-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: