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General NPI Number Information
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NPI Number | 1245194141
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Entity Type | Individual
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Provider Name | K'NETHA MESHUN FAGGART
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 517 DEBRA CIR SW
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City | CONCORD
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State | NC
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Zip | 28025-8992
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Country | US
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Telephone | 980-331-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 AMETHYST LN NW APT 11210
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City | CHARLOTTE
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State | NC
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Zip | 28262-5074
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Country | US
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Telephone | 980-331-4031
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | NC
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