Provider Demographics
NPI:1902040538
Name:FABRICK, JOANNE MADELINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MADELINE
Last Name:FABRICK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 POST OAK LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5218
Mailing Address - Country:US
Mailing Address - Phone:214-535-8422
Mailing Address - Fax:
Practice Address - Street 1:1824 POST OAK LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5218
Practice Address - Country:US
Practice Address - Phone:214-535-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18101171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18101OtherLICENSED PRACTICING COUNSELOR