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General NPI Number Information
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NPI Number | 1053187559
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Entity Type | Organization
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Legal Business Name | FAITH AT WORK LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 110 E HICKS ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-1805
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Country | US
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Telephone | 434-532-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E HICKS ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-1805
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Country | US
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Telephone | 434-532-3069
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Fax | 804-280-8097
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Authorized Official
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Title or Position | APRN/OWNER
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Name | ANGELA ALLEN-BLAINE
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Credential | APRN-BC
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Telephone | 434-917-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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