Healthcare Provider Details

I. General information

NPI: 1639677297
Provider Name (Legal Business Name): LINDSAY J FABER LMHC, QS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 A1A S STE A
ST AUGUSTINE FL
32080-5582
US

IV. Provider business mailing address

209 E PISA PL
ST AUGUSTINE FL
32084-2585
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-4524
  • Fax:
Mailing address:
  • Phone: 904-826-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18391
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: