Organization
FAITH SPRINGS ETERNAL (FASE), PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMANI NIA JOHNSON (OWNER)
(678) 612-6699
Entity
Organization
Contact information
Practice address
910 HOPE MILLS RD, FAYETTEVILLE, NC 28304-4243
(919) 888-6397
Mailing address
910 HOPE MILLS RD, FAYETTEVILLE, NC 28304-4243
(919) 888-6397
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073938254
—
NC
Enumeration date
04/01/2020
Last updated
07/01/2021
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