Provider Demographics
NPI:1053187559
Name:FAITH AT WORK LLC
Entity type:Organization
Organization Name:FAITH AT WORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN-BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:434-917-0970
Mailing Address - Street 1:110 E HICKS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1805
Mailing Address - Country:US
Mailing Address - Phone:434-532-3069
Mailing Address - Fax:804-280-8097
Practice Address - Street 1:110 E HICKS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1805
Practice Address - Country:US
Practice Address - Phone:434-532-3069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health