Provider Demographics
NPI:1831315100
Name:NORTHINGTON, FAITH LORRAINE (MS MHC)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:LORRAINE
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:74 5533 LUHIA ST
Mailing Address - Street 2:STE # B 1A 394
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-722-6755
Mailing Address - Fax:808-443-0213
Practice Address - Street 1:74 5533 LUHIA ST
Practice Address - Street 2:STE # B 1A 394
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-722-6755
Practice Address - Fax:808-443-0213
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI169101YM0800X
SC4006101YP2500X
NC4245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102870Medicaid