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General NPI Number Information
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NPI Number | 1568872158
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Entity Type | Organization
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Legal Business Name | FAITHWAYS DIRECTION SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 2443 TIGNOR RD
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City | RICHMOND
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State | VA
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Zip | 23224-6185
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Country | US
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Telephone | 804-840-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 2443 TIGNOR RD
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City | RICHMOND
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State | VA
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Zip | 23224-6185
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Country | US
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Telephone | 804-840-8446
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAMEKA LAVONDA WHITE
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Credential |
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Telephone | 804-840-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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