Healthcare Provider Details

I. General information

NPI: 1083348395
Provider Name (Legal Business Name): GUIDED BY FAITH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 JEFFERSON AVE STE 108A
NEWPORT NEWS VA
23601-2551
US

IV. Provider business mailing address

11116 JEFFERSON AVE STE 108A
NEWPORT NEWS VA
23601-2551
US

V. Phone/Fax

Practice location:
  • Phone: 757-593-1547
  • Fax: 757-687-0650
Mailing address:
  • Phone: 757-593-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENOHN CARTER
Title or Position: OWNER
Credential: LPC
Phone: 757-593-1547