Healthcare Provider Details

I. General information

NPI: 1669395992
Provider Name (Legal Business Name): DEBRA AASE-FARNUM MA, LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 E 7TH ST
CHARLOTTE NC
28204-2416
US

IV. Provider business mailing address

1240 BURTONWOOD CIR
CHARLOTTE NC
28212-7011
US

V. Phone/Fax

Practice location:
  • Phone: 704-426-3711
  • Fax:
Mailing address:
  • Phone: 980-800-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23212
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: