Provider Demographics
NPI:1750166864
Name:BAREFOOT, FALLON MILLER
Entity type:Individual
Prefix:
First Name:FALLON
Middle Name:MILLER
Last Name:BAREFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3169
Mailing Address - Country:US
Mailing Address - Phone:919-234-1546
Mailing Address - Fax:
Practice Address - Street 1:956 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3169
Practice Address - Country:US
Practice Address - Phone:919-234-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician