MEDICARE: LOVING FAITH, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	COO5741	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851574321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING FAITH, PLLC

Provider Business Mailing Address
First Line	:	2932 BREEZEWOOD AVE
Second Line	:	206
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5505
Country	:	US
Telephone Number	:	910-366-6314
Fax Number	:	910-482-3877

Provider Business Practice Location Address
First Line	:	2932 BREEZEWOOD AVE
Second Line	:	206
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5505
Country	:	US
Telephone Number	:	910-366-6314
Fax Number	:	910-482-3877

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRIS L EDMONDS
Credential	:	LCSW
Telephone Number	:	910-366-6314

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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