Healthcare Provider Details

I. General information

NPI: 1629935176
Provider Name (Legal Business Name): MIA FAITH HAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA FAITH DEEL

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BROAD ST
MARION VA
24354-2725
US

IV. Provider business mailing address

770 W RIDGE RD
WYTHEVILLE VA
24382-1187
US

V. Phone/Fax

Practice location:
  • Phone: 276-781-5900
  • Fax:
Mailing address:
  • Phone: 276-223-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015048
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: