Provider Demographics
NPI:1003956236
Name:FAIN, JAMIE F (CADC, LAC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:F
Last Name:FAIN
Suffix:
Gender:F
Credentials:CADC, LAC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:F
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC, LAC
Mailing Address - Street 1:3308 REDWOOD CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7731
Mailing Address - Country:US
Mailing Address - Phone:870-219-3606
Mailing Address - Fax:
Practice Address - Street 1:3308 REDWOOD CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7731
Practice Address - Country:US
Practice Address - Phone:870-219-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA9812050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1063OtherC.A.D.C.