Healthcare Provider Details

I. General information

NPI: 1104973189
Provider Name (Legal Business Name): ANNE PATRICIA FAHY RN, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON RD SUITE103
ATHENS GA
30606-7204
US

IV. Provider business mailing address

151 NC HIGHWAY 9 SUITE B #116
BLACK MOUNTAIN NC
28711-3456
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-7041
  • Fax: 706-850-7042
Mailing address:
  • Phone: 949-290-8378
  • Fax: 828-664-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3857
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number7446645
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23056
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC007454
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number248219
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: