Provider Demographics
NPI:1093193096
Name:FAIRFAX, BARBARA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:HARDEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-A
Mailing Address - Street 1:583 OLD CARTRETTE RD
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:NC
Mailing Address - Zip Code:28432-8819
Mailing Address - Country:US
Mailing Address - Phone:910-880-0575
Mailing Address - Fax:
Practice Address - Street 1:220 RONNIE CT STE 2
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4192
Practice Address - Country:US
Practice Address - Phone:910-880-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health