Organization Name: | JESSE FAIRCHILD LLC |
NPI Number: | 1467724013 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JANICE FAIRCHILD (OWNER) |
Mailing Address: | 2327 Pulaski Hwy Suite 101b North East |
State: | MD US |
Postal Code: | 219013706 |
Phone Number: | 4438774044 |
Fax Number: | 4435057065 |
NPI Enumeration Date: | 01/29/2012 |
NPI Last Update Date: | 01/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC2857 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |