Provider Demographics
NPI:1558508929
Name:COSTEA, FAITH LEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:LEE
Last Name:COSTEA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 DRAYTON CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-7293
Mailing Address - Country:US
Mailing Address - Phone:269-598-8810
Mailing Address - Fax:
Practice Address - Street 1:6109 SAN GABRIEL APT E
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8108
Practice Address - Country:US
Practice Address - Phone:269-598-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL14164431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical