Provider Demographics
NPI:1750570719
Name:FAYRIE, ERICA (LCMHC, LMHC, ATR)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FAYRIE
Suffix:
Gender:F
Credentials:LCMHC, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-0512
Mailing Address - Country:US
Mailing Address - Phone:802-552-8604
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1367
Practice Address - Country:US
Practice Address - Phone:802-552-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6164101YM0800X
VT068.0134143101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health