Provider Demographics
NPI:1295948479
Name:FAISON, CARLA M (LPCC)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:M
Last Name:FAISON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED HARTMAN HWY
Mailing Address - Street 2:STE 116
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2830
Mailing Address - Country:US
Mailing Address - Phone:513-563-4442
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY
Practice Address - Street 2:STE 116
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2830
Practice Address - Country:US
Practice Address - Phone:513-563-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002709S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11510987OtherCAQH NUMBER
OH1235246778OtherHOPE CHRISTIAN CN INCNPI
OHE0002709SOtherMENTAL HEALTH COUNSELOR
OH000000380132Other000000380132 ANTHEM PIN
OH7321149OtherAETNA PIN NUMBER