Basic Information
| Provider Information | |||||||||
| NPI: | 1306907092 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAITH BASED COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406539252 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | SUITE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406539252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/31/2007 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | SONIA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MGR BILLING | ||||||||
| AuthorizedOfficialTelephone: | 7406548716 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.