Provider Demographics
NPI:1710335930
Name:FADEL, ADAM TARRY (LMFTA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:TARRY
Last Name:FADEL
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18805 W. CATAWBA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4608
Mailing Address - Country:US
Mailing Address - Phone:704-363-3032
Mailing Address - Fax:
Practice Address - Street 1:18805 W. CATAWBA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4608
Practice Address - Country:US
Practice Address - Phone:704-363-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11049A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist