Healthcare Provider Details

I. General information

NPI: 1689507352
Provider Name (Legal Business Name): MS. NAKISHA MONIQUE FAUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 EVA ST
DURHAM NC
27703-2013
US

IV. Provider business mailing address

3624 WALEBACK LN
RALEIGH NC
27610-6818
US

V. Phone/Fax

Practice location:
  • Phone: 919-903-7922
  • Fax:
Mailing address:
  • Phone: 919-903-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: