Healthcare Provider Details

I. General information

NPI: 1316838295
Provider Name (Legal Business Name): FAITHFUL FOUNDATIONS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GLADE ST SE
WISE VA
24293-5711
US

IV. Provider business mailing address

203 GLADE ST SE
WISE VA
24293-5711
US

V. Phone/Fax

Practice location:
  • Phone: 276-708-7386
  • Fax: 877-497-4833
Mailing address:
  • Phone: 276-708-7386
  • Fax: 877-497-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: REBECCA TROUT
Title or Position: CLINICAL SUPERVISOR
Credential: MSPC LPC NCC
Phone: 724-420-2794