Healthcare Provider Details

I. General information

NPI: 1932045689
Provider Name (Legal Business Name): FAIRFAX ROAD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 ROAD TO HAPPINESS
VERMILION OH
44089-1035
US

IV. Provider business mailing address

808 ROAD TO HAPPINESS
VERMILION OH
44089-1035
US

V. Phone/Fax

Practice location:
  • Phone: 714-420-8816
  • Fax:
Mailing address:
  • Phone: 714-420-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNDREA ROGERS
Title or Position: DIRECTOR
Credential: LPCC
Phone: 714-420-8816