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General NPI Number Information
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NPI Number | 1407082886
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Entity Type | Organization
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Legal Business Name | FAITH COUNSELING AND CLINICAL CONSULTATION SERVICES, PLLC
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Dates
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Enumeration Date | 05/30/2009
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Last Update Date | 05/30/2009
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Provider Practice Location Address
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Address Line | 103 E KING ST
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City | EDENTON
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State | NC
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Zip | 27932-1957
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Country | US
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Telephone | 252-482-1770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 89
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City | EDENTON
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State | NC
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Zip | 27932-0089
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Country | US
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Telephone | 252-482-1770
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS FELICIA JANE COFIELD
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Credential | LCSW
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Telephone | 252-312-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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