Provider Demographics
NPI:1700478229
Name:FAISON, TERRI (LCMHC-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:FAISON
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TRAIL ONE APT 205F
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6595
Mailing Address - Country:US
Mailing Address - Phone:910-290-2721
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 4005
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2566
Practice Address - Country:US
Practice Address - Phone:919-999-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27019101YA0400X
NCA16385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)