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General NPI Number Information
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NPI Number | 1437021078
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Entity Type | Individual
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Provider Name | LIN MARTISH FAMBRO LCAS-A
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Gender | Female
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1455 E FRANKLIN BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-4059
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Country | US
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Telephone | 980-285-2990
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Fax | 704-842-3754
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Provider Business Mailing Address
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Address Line | 9930 SEASON GROVE LN APT 207
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City | CHARLOTTE
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State | NC
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Zip | 28216-6623
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Country | US
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Telephone | 980-285-2990
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Fax | 704-842-3754
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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 |
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License Number State |
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