Healthcare Provider Details

I. General information

NPI: 1417892142
Provider Name (Legal Business Name): FAITH WELLNESS FACTORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945B N ELDER DR
SHAW AFB SC
29152-7915
US

IV. Provider business mailing address

7945B N ELDER DR
SHAW AFB SC
29152-7915
US

V. Phone/Fax

Practice location:
  • Phone: 281-736-7729
  • Fax:
Mailing address:
  • Phone: 281-736-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KENASIA GLOVER
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 281-736-7729