Provider Demographics
NPI:1003665704
Name:F.A.I.T.H BEHAVIORAL SUPPORT
Entity type:Organization
Organization Name:F.A.I.T.H BEHAVIORAL SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:SHERII
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LGSW
Authorized Official - Phone:304-343-0044
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-7105
Mailing Address - Country:US
Mailing Address - Phone:304-550-5030
Mailing Address - Fax:
Practice Address - Street 1:301 WASHINGTON ST W STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2230
Practice Address - Country:US
Practice Address - Phone:304-951-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY SEPTEMBER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care