Healthcare Provider Details

I. General information

NPI: 1114883006
Provider Name (Legal Business Name): KALEIGH FAIRBAIRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 ROSEWOOD DR STE 300
DANVERS MA
01923-1388
US

IV. Provider business mailing address

PO BOX 1056
SALEM MA
01970-6156
US

V. Phone/Fax

Practice location:
  • Phone: 978-494-8163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: