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General NPI Number Information
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NPI Number | 1306085378
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Entity Type | Individual
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Provider Name | MAGGIE FARDELLA LPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 201 E 9TH ST
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City | DALLAS
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State | TX
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Zip | 75203
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Country | US
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Telephone | 972-502-4019
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Fax | 972-502-4001
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Provider Business Mailing Address
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Address Line | 201 E 9TH ST
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City | DALLAS
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State | TX
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Zip | 75203-2229
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Country | US
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Telephone | 729-502-4000
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Fax | 972-502-4001
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63093
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License Number State | TX
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