MEDICARE: FAITH HORIZON COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP1600X	Pastoral Counselor
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427681691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HORIZON COUNSELING LLC

Provider Business Mailing Address
First Line	:	207 RONDELAY DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-9701
Country	:	US
Telephone Number	:	919-702-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 S MIAMI BLVD STE 232
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-4900
Country	:	US
Telephone Number	:	919-702-3652
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOHN WINSTON SMITH JR.
Credential	:	LCSW
Telephone Number	:	919-702-3652

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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