Provider Demographics
NPI:1407082886
Name:FAITH COUNSELING AND CLINICAL CONSULTATION SERVICES, PLLC
Entity Type:Organization
Organization Name:FAITH COUNSELING AND CLINICAL CONSULTATION SERVICES, PLLC
Other - Org Name:FAITH COUNSELING AND CLINICAL CONSULTATION SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-312-6670
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0089
Mailing Address - Country:US
Mailing Address - Phone:252-482-1770
Mailing Address - Fax:
Practice Address - Street 1:103 E KING ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1957
Practice Address - Country:US
Practice Address - Phone:252-482-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health