Provider Demographics
NPI:1851574321
Name:LOVING FAITH, PLLC
Entity Type:Organization
Organization Name:LOVING FAITH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-366-6314
Mailing Address - Street 1:2932 BREEZEWOOD AVE
Mailing Address - Street 2:206
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5505
Mailing Address - Country:US
Mailing Address - Phone:910-366-6314
Mailing Address - Fax:910-482-3877
Practice Address - Street 1:2932 BREEZEWOOD AVE
Practice Address - Street 2:206
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5505
Practice Address - Country:US
Practice Address - Phone:910-366-6314
Practice Address - Fax:910-482-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO57411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106733Medicaid