Provider Demographics
NPI:1578059663
Name:FAIGLE, TARA (MA, NCC, LAC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FAIGLE
Suffix:
Gender:F
Credentials:MA, NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STRIMPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1702
Mailing Address - Country:US
Mailing Address - Phone:609-577-7373
Mailing Address - Fax:
Practice Address - Street 1:770 NEWTOWN YARDLEY RD STE 214
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4501
Practice Address - Country:US
Practice Address - Phone:609-577-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ37AC88387600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor