Provider Demographics
NPI:1689865230
Name:FAIN, STEVEN MARK
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:FAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5989 VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5629
Mailing Address - Country:US
Mailing Address - Phone:256-413-1439
Mailing Address - Fax:
Practice Address - Street 1:506 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5217
Practice Address - Country:US
Practice Address - Phone:256-547-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33905085Medicare PIN