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General NPI Number Information
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NPI Number | 1144816083
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Entity Type | Organization
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Legal Business Name | FAITH COMMUNITY DISEASE PREVENTION AND HEALTH PROMOTION FOUNDATION
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 319 NECHES STREET
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City | JACKSONVILLE
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State | TX
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Zip | 75766-4931
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Country | US
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Telephone | 430-244-9250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2362
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City | JACKSONVILLE
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State | TX
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Zip | 75766-0086
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Country | US
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Telephone | 903-284-0056
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHERYL YVETTE LEWIS-BATTLES
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Credential | APRN, PMHNP
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Telephone | 903-284-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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