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General NPI Number Information
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NPI Number | 1780127589
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Entity Type | Organization
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Legal Business Name | FAITH CHRISTIAN MINISTRY NON-DENOMINATIONAL CHURCH INC.
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 7400 BEAUFONT SPRINGS DRIVE SUITE 300
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City | RICHMOND
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State | VA
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Zip | 23225
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Country | US
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Telephone | 866-720-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 7306 SUMMERTREE DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-5935
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Country | US
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Telephone | 866-720-5321
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Fax |
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Authorized Official
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Title or Position | PASTOR/PASTORAL COUNSELOR
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Name | DR. MONA JUANITA PETERSON-OMOTOLA
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Credential | REV. DR. PH.D.
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Telephone | 866-720-5321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 14946
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License Number State | VA
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