Provider Demographics
NPI:1164958377
Name:FAIRHAVEN COUNSELING
Entity type:Organization
Organization Name:FAIRHAVEN COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC, LPC, MHSP, NCC
Authorized Official - Phone:423-772-0044
Mailing Address - Street 1:2198 RIPSHIN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3762
Mailing Address - Country:US
Mailing Address - Phone:423-772-0044
Mailing Address - Fax:
Practice Address - Street 1:2198 RIPSHIN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3762
Practice Address - Country:US
Practice Address - Phone:423-772-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3669251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health