Healthcare Provider Details

I. General information

NPI: 1184534117
Provider Name (Legal Business Name): EMILY GENEVIEVE FAIRCHILD BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LARCH ST
SCRANTON PA
18509-2802
US

IV. Provider business mailing address

32 BROWNCREST DR
WEST WYOMING PA
18644-1202
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax:
Mailing address:
  • Phone: 570-212-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: