Provider Demographics
NPI:1336731751
Name:FALCO, PHILIP MICHAEL (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:FALCO
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 AVELON VALLEY DR APT 937
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4580
Mailing Address - Country:US
Mailing Address - Phone:425-590-7783
Mailing Address - Fax:
Practice Address - Street 1:7300 CARMEL EXECUTIVE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1307
Practice Address - Country:US
Practice Address - Phone:704-398-3928
Practice Address - Fax:704-398-3928
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health