Healthcare Provider Details

I. General information

NPI: 1366304875
Provider Name (Legal Business Name): HIRAM JACOB FAIRCLOTH LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6482 COUNTY ROAD 2262
TROY AL
36079-3234
US

IV. Provider business mailing address

6482 COUNTY ROAD 2262
TROY AL
36079-3234
US

V. Phone/Fax

Practice location:
  • Phone: 334-465-9990
  • Fax:
Mailing address:
  • Phone: 586-863-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05643
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: