Healthcare Provider Details

I. General information

NPI: 1801599329
Provider Name (Legal Business Name): MARTIN P FAISON CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HUBERT ST STE 2-P
RALEIGH NC
27603-2301
US

IV. Provider business mailing address

315 HUBERT ST STE 2-P
RALEIGH NC
27603-2301
US

V. Phone/Fax

Practice location:
  • Phone: 919-410-6817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number619692
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: