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General NPI Number Information
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NPI Number | 1245398668
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Entity Type | Individual
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Provider Name | CONNIE M FAIRCHILD MA LPC CAC I
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 315 E DALE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1102
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Country | US
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Telephone | 719-291-5623
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Fax | 219-473-4066
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Provider Business Mailing Address
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Address Line | PO BOX 2687
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-2687
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Country | US
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Telephone | 719-291-5623
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Fax | 219-473-4066
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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 | 5708CAC
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC1385
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License Number State | CO
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