Provider Demographics
NPI:1114241023
Name:FACER, DAVID (PLCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FACER
Suffix:
Gender:M
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 COPPER RIDGE DR
Mailing Address - Street 2:#104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5566
Mailing Address - Country:US
Mailing Address - Phone:919-764-2171
Mailing Address - Fax:919-764-2274
Practice Address - Street 1:300 VEAZEY DR
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1668
Practice Address - Country:US
Practice Address - Phone:919-764-2171
Practice Address - Fax:919-764-2274
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0053681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical