Provider Demographics
NPI:1477919439
Name:FAFORD, JAMIELYN L
Entity Type:Individual
Prefix:
First Name:JAMIELYN
Middle Name:L
Last Name:FAFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIEL
Other - Middle Name:L
Other - Last Name:FAFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4160 HOALA ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1452
Mailing Address - Country:US
Mailing Address - Phone:808-346-8043
Mailing Address - Fax:
Practice Address - Street 1:4160 HOALA ST APT 5B
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-346-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI000008211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst