Provider Demographics
NPI:1164620043
Name:FAIRCHILD, JANICE LESLIE (MS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LESLIE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3920
Mailing Address - Country:US
Mailing Address - Phone:443-877-4044
Mailing Address - Fax:443-505-7065
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3920
Practice Address - Country:US
Practice Address - Phone:443-877-4044
Practice Address - Fax:443-505-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional