Healthcare Provider Details

I. General information

NPI: 1912748211
Provider Name (Legal Business Name): FAITH HEALTHCARE AND HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 1/2
POINT PLEASANT WV
25550-1121
US

IV. Provider business mailing address

8674 BLACK OAK ROAD
FRAZIERS BOTTOM WV
25082
US

V. Phone/Fax

Practice location:
  • Phone: 304-812-5426
  • Fax: 304-812-5427
Mailing address:
  • Phone: 304-812-5426
  • Fax: 304-812-5427

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA QUEEN
Title or Position: OWNER/THERAPIST
Credential:
Phone: 304-812-5426