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General NPI Number Information
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NPI Number | 1912794314
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Entity Type | Organization
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Legal Business Name | FAITH AND TRANSFORMATION CENTER LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 4519 WOODBINE RD
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City | PACE
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State | FL
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Zip | 32571-8706
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Country | US
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Telephone | 850-979-4432
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Fax | 850-366-1070
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Provider Business Mailing Address
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Address Line | 8264 HIGHWAY 89
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City | MILTON
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State | FL
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Zip | 32570-9048
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Country | US
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Telephone | 850-449-9340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARISSA HEMLEY
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Credential |
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Telephone | 850-449-9340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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