=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437408580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITH ASSEMBLY CHRISTIAN CENTER WORD OF TRUTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2012
-----------------------------------------------------
Last Update Date | 09/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 S NEW HOPE RD 105
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-231-1251
-----------------------------------------------------
Fax | 919-231-1252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 S NEW HOPE RD 105
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-231-1251
-----------------------------------------------------
Fax | 919-231-1252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FREIDA HOYT-CATES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-231-1251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------