Healthcare Provider Details

I. General information

NPI: 1891579207
Provider Name (Legal Business Name): FAITH ANTOINETTE STORY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST # AH
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

601 REGENCY DR
DEER PARK TX
77536-6174
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax:
Mailing address:
  • Phone: 832-766-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number52413
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number52413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: