Provider Demographics
NPI:1447997341
Name:FAITHFUL COUNSELING AND THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:FAITHFUL COUNSELING AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC LMHC
Authorized Official - Phone:312-406-3776
Mailing Address - Street 1:5401 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1170
Mailing Address - Country:US
Mailing Address - Phone:312-406-3776
Mailing Address - Fax:
Practice Address - Street 1:57 MICHIGAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:312-406-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1302266OtherANTHEM BLUE CROSS AND BLUE SHIELD