Provider Demographics
NPI:1184817264
Name:FARRAR, JOHN VINCENT I (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:FARRAR
Suffix:I
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32437 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3039
Mailing Address - Country:US
Mailing Address - Phone:248-210-3556
Mailing Address - Fax:734-421-0306
Practice Address - Street 1:32437 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3039
Practice Address - Country:US
Practice Address - Phone:248-210-3556
Practice Address - Fax:734-421-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003498101Y00000X
MISARF 821679101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor