Provider Demographics
NPI:1225512445
Name:FAIRFAX, YOLANDA CEMORA (LPC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:CEMORA
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2598
Mailing Address - Country:US
Mailing Address - Phone:614-751-1090
Mailing Address - Fax:614-751-1091
Practice Address - Street 1:6173 NORTHBEND DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9133
Practice Address - Country:US
Practice Address - Phone:614-751-1090
Practice Address - Fax:614-751-1091
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health