Provider Demographics
NPI:1346863719
Name:CREECH, FAITH VICTORIA WILSON
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:VICTORIA WILSON
Last Name:CREECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16717 US HIGHWAY 17 STE 210
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3696
Mailing Address - Country:US
Mailing Address - Phone:910-619-8377
Mailing Address - Fax:
Practice Address - Street 1:16717 US HIGHWAY 17 STE 210
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3696
Practice Address - Country:US
Practice Address - Phone:910-619-8377
Practice Address - Fax:910-406-1255
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician