Healthcare Provider Details

I. General information

NPI: 1922932441
Provider Name (Legal Business Name): MYKIA DANYELL ELAINE FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 ARDSLEY RD N
WILSON NC
27896-6937
US

IV. Provider business mailing address

4200 CYPRESS DR NW APT B
WILSON NC
27896-7615
US

V. Phone/Fax

Practice location:
  • Phone: 919-848-0132
  • Fax:
Mailing address:
  • Phone: 252-294-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP023316
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: