Provider Demographics
NPI:1942580824
Name:FAGAN, MICHAEL (LPC, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FAGAN
Suffix:
Gender:M
Credentials:LPC, LCAS, CCS
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 6892
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-6892
Mailing Address - Country:US
Mailing Address - Phone:828-713-7991
Mailing Address - Fax:
Practice Address - Street 1:70 WOODFIN PL STE 326A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-8403
Practice Address - Country:US
Practice Address - Phone:828-713-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1757101YA0400X
NC7779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional