Provider Demographics
NPI:1790559441
Name:FESMIRE, EMILY (LCMHCA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FESMIRE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MCLEOD ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1708
Mailing Address - Country:US
Mailing Address - Phone:980-446-6050
Mailing Address - Fax:
Practice Address - Street 1:9719 NORTHEAST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9713
Practice Address - Country:US
Practice Address - Phone:980-217-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health