Provider Demographics
NPI:1245395854
Name:FAIR, MARILYN HART (LMHC, MAC, CFM)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:HART
Last Name:FAIR
Suffix:
Gender:F
Credentials:LMHC, MAC, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 WAYMONT CT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3566
Mailing Address - Country:US
Mailing Address - Phone:407-322-2330
Mailing Address - Fax:407-324-0075
Practice Address - Street 1:305 WAYMONT CT
Practice Address - Street 2:SUITE 111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3566
Practice Address - Country:US
Practice Address - Phone:407-322-2330
Practice Address - Fax:407-324-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP333101YA0400X
FLMH0002711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health