Provider Demographics
NPI:1134457542
Name:FCC ASSOCIATES
Entity Type:Organization
Organization Name:FCC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-858-3777
Mailing Address - Street 1:PO BOX 635219
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5219
Mailing Address - Country:US
Mailing Address - Phone:513-858-3777
Mailing Address - Fax:513-858-3000
Practice Address - Street 1:780 NILLES RD STE F1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3644
Practice Address - Country:US
Practice Address - Phone:513-858-3777
Practice Address - Fax:513-858-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty