Provider Demographics
NPI:1528480027
Name:BEAR FAITH LLC
Entity type:Organization
Organization Name:BEAR FAITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-373-5422
Mailing Address - Street 1:PO BOX 8285
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-8285
Mailing Address - Country:US
Mailing Address - Phone:302-373-5422
Mailing Address - Fax:302-656-8512
Practice Address - Street 1:2401 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 103 A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1401
Practice Address - Country:US
Practice Address - Phone:302-373-5422
Practice Address - Fax:302-656-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty