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General NPI Number Information
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NPI Number | 1104254143
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Entity Type | Individual
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Provider Name | DIANE FAHY M.ED, LPCA, NCC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 8390 SIX FORKS RD SUITE 201
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City | RALEIGH
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State | NC
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Zip | 27615-3060
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Country | US
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Telephone | 919-247-4703
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Fax | 919-782-8731
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Provider Business Mailing Address
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Address Line | 3912 GRANDBRIDGE DR.
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City | APEX
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State | NC
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Zip | 27539-2753
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Country | US
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Telephone | 919-247-4703
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A9844
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License Number State | NC
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