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General NPI Number Information
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NPI Number | 1134457542
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Entity Type | Organization
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Legal Business Name | FCC ASSOCIATES
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 780 NILLES RD STE F1
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City | FAIRFIELD
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State | OH
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Zip | 45014-3644
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Country | US
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Telephone | 513-858-3777
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Fax | 513-858-3000
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Provider Business Mailing Address
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Address Line | PO BOX 635219
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City | CINCINNATI
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State | OH
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Zip | 45263-5219
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Country | US
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Telephone | 513-858-3777
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Fax | 513-858-3000
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID DRAKE
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Credential | PHD
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Telephone | 513-858-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4862
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License Number State | OH
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