Organization
HOUSE OF PRAYER CHRISTIAN ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY DEWAYNE PETTIFORD (CEO)
(618) 274-3850
Entity
Organization
Contact information
Practice address
5501 N PARK DR, EAST SAINT LOUIS, IL 62204-2121
(618) 274-3850
Mailing address
5501 N PARK DR, EAST SAINT LOUIS, IL 62204-2121
(618) 274-3850
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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