Provider Demographics
NPI:1942471503
Name:FACCI, ANDREA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:F
Last Name:FACCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2286
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-2286
Mailing Address - Country:US
Mailing Address - Phone:252-255-1847
Mailing Address - Fax:252-480-1800
Practice Address - Street 1:5108 N CROATAN HWY
Practice Address - Street 2:SUITE 311
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3988
Practice Address - Country:US
Practice Address - Phone:252-255-1847
Practice Address - Fax:252-480-1800
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 1057101YA0400X
NCLPC 5189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)