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General NPI Number Information
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NPI Number | 1487436952
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Entity Type | Individual
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Provider Name | FAITH BRAY
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Gender | Female
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 3419 VIRGINIA BEACH BLVD #5079
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452
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Country | US
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Telephone | 757-952-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 520 LUMMIS RD
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City | SUFFOLK
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State | VA
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Zip | 23434-8509
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Country | US
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Telephone | 757-472-2414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0704016417
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License Number State | VA
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