Provider Demographics
NPI:1346706181
Name:MIRE, FAITH NICOLE (BS, CIT)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:NICOLE
Last Name:MIRE
Suffix:
Gender:F
Credentials:BS, CIT
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:NICOLE
Other - Last Name:MIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, CIT
Mailing Address - Street 1:1314 N LAFITTE RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-3149
Mailing Address - Country:US
Mailing Address - Phone:337-893-5588
Mailing Address - Fax:337-893-5556
Practice Address - Street 1:1314 N LAFITTE RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-3149
Practice Address - Country:US
Practice Address - Phone:337-893-5588
Practice Address - Fax:337-893-5556
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)