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General NPI Number Information
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NPI Number | 1356706238
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Entity Type | Individual
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Provider Name | JENNIFER FADDIS MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 3980 W WEDINGTON DR STE 9
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5791
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Country | US
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Telephone | 479-263-7602
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | CENTERTON
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State | AR
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Zip | 72719
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Country | US
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Telephone | 479-903-1263
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P0301002
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License Number State | AR
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