Provider Demographics
NPI:1023357746
Name:FYFFE, JAMERILLA B (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:JAMERILLA
Middle Name:B
Last Name:FYFFE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 BARRISTER WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1663
Mailing Address - Country:US
Mailing Address - Phone:704-395-0304
Mailing Address - Fax:
Practice Address - Street 1:1100 S MINT ST
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4049
Practice Address - Country:US
Practice Address - Phone:704-412-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional