Provider Demographics
NPI:1447130679
Name:FAITH AND TRUST PSYCHIATRIC LIVING
Entity type:Organization
Organization Name:FAITH AND TRUST PSYCHIATRIC LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOHTUNG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:571-762-9099
Mailing Address - Street 1:9222 ALVYN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-6150
Mailing Address - Country:US
Mailing Address - Phone:571-762-9099
Mailing Address - Fax:
Practice Address - Street 1:11 SMOKEHOUSE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8455
Practice Address - Country:US
Practice Address - Phone:571-762-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)