Provider Demographics
NPI:1558533133
Name:FAVRET, WILLIAM R (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:FAVRET
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 ASHEMONT RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-7317
Mailing Address - Country:US
Mailing Address - Phone:910-281-4946
Mailing Address - Fax:
Practice Address - Street 1:1892 ASHEMONT RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-7317
Practice Address - Country:US
Practice Address - Phone:910-281-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist