Provider Demographics
NPI:1699194845
Name:FADEL, NATALIE M (PSYD LLC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:FADEL
Suffix:
Gender:F
Credentials:PSYD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-2316
Mailing Address - Country:US
Mailing Address - Phone:864-978-5383
Mailing Address - Fax:864-591-3001
Practice Address - Street 1:152 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-2316
Practice Address - Country:US
Practice Address - Phone:864-978-5383
Practice Address - Fax:864-591-3001
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1248103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0546Medicaid
SCPS0546Medicaid