Provider Demographics
NPI:1639800477
Name:FAITH AND THERAPY, LLC
Entity Type:Organization
Organization Name:FAITH AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:334-790-9475
Mailing Address - Street 1:1083 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-6176
Mailing Address - Country:US
Mailing Address - Phone:334-790-9475
Mailing Address - Fax:
Practice Address - Street 1:187 BELMONT DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-6500
Practice Address - Country:US
Practice Address - Phone:334-671-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1811583735Medicaid