Provider Demographics
NPI:1942548219
Name:MUMME, FAYEDRA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:FAYEDRA
Middle Name:
Last Name:MUMME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 N CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3414
Mailing Address - Country:US
Mailing Address - Phone:704-871-0934
Mailing Address - Fax:
Practice Address - Street 1:913 N CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3414
Practice Address - Country:US
Practice Address - Phone:704-871-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional