Provider Demographics
NPI:1164913596
Name:FAGGART, DAMARIUS RAYMOND
Entity Type:Individual
Prefix:
First Name:DAMARIUS
Middle Name:RAYMOND
Last Name:FAGGART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BW THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7230
Mailing Address - Country:US
Mailing Address - Phone:704-421-6481
Mailing Address - Fax:
Practice Address - Street 1:503 AMHURST DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-421-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor