Provider Demographics
NPI:1235285032
Name:FAISON, BOBBY (LCAS)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:FAISON
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N GARNETT ST
Mailing Address - Street 2:SUITE F.
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4673
Mailing Address - Country:US
Mailing Address - Phone:252-433-0300
Mailing Address - Fax:252-433-8054
Practice Address - Street 1:208 N GARNETT ST
Practice Address - Street 2:SUITE F.
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4673
Practice Address - Country:US
Practice Address - Phone:252-433-0300
Practice Address - Fax:252-433-8054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC875101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)