=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316838295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITHFUL FOUNDATIONS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 GLADE ST SE
-----------------------------------------------------
City | WISE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24293-5711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-393-4387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 GLADE ST SE
-----------------------------------------------------
City | WISE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24293-5711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SUPERVISOR
-----------------------------------------------------
Name | REBECCA TROUT
-----------------------------------------------------
Credential | MSPC LPC NCC
-----------------------------------------------------
Telephone | 724-420-2794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------