Provider Demographics
NPI:1205282993
Name:DARLENE P. FAIRLEY LPC PLLC
Entity type:Organization
Organization Name:DARLENE P. FAIRLEY LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:FAIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-273-0625
Mailing Address - Street 1:351 WAGONER DR
Mailing Address - Street 2:SUITE 313
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4608
Mailing Address - Country:US
Mailing Address - Phone:910-273-0625
Mailing Address - Fax:910-568-3690
Practice Address - Street 1:351 WAGONER DR
Practice Address - Street 2:SUITE 313
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4608
Practice Address - Country:US
Practice Address - Phone:910-273-0625
Practice Address - Fax:910-568-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty