Healthcare Provider Details

I. General information

NPI: 1720332208
Provider Name (Legal Business Name): DAVID FAFORE LCSW-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 GLADE SPRING LN
CHARLOTTE NC
28216-8889
US

IV. Provider business mailing address

8936 GLADE SPRING LN
CHARLOTTE NC
28216-8889
US

V. Phone/Fax

Practice location:
  • Phone: 202-468-6414
  • Fax:
Mailing address:
  • Phone: 202-468-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP-007051
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: