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General NPI Number Information
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NPI Number | 1104241637
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Entity Type | Individual
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Provider Name | SUSAN DELAINE FARIS MA, LCDC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 2340 TRINITY MILLS SUITE 300
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City | CARROLLTON
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State | TX
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Zip | 75006
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Country | US
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Telephone | 972-814-3392
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Fax | 972-417-2800
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Provider Business Mailing Address
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Address Line | P.O. BOX 475
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City | LEWISVILLE
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State | TX
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Zip | 75067
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Country | US
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Telephone | 972-814-3392
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Fax | 972-417-2800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7514
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License Number State | TX
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