Provider Demographics
NPI:1821411893
Name:FACEY, AYANNA DARA (LMHC)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:DARA
Last Name:FACEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 ALHAMBRA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5823
Mailing Address - Country:US
Mailing Address - Phone:954-775-4591
Mailing Address - Fax:
Practice Address - Street 1:14900 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-7329
Practice Address - Country:US
Practice Address - Phone:754-444-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health