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General NPI Number Information
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NPI Number | 1467724013
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Entity Type | Organization
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Legal Business Name | JESSE FAIRCHILD LLC
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Dates
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Enumeration Date | 01/29/2012
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Last Update Date | 01/10/2026
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Provider Practice Location Address
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Address Line | 2057 PULASKI HWY STE 4
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City | NORTH EAST
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State | MD
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Zip | 21901-3744
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Country | US
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Telephone | 443-877-4044
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Fax | 443-967-0077
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Provider Business Mailing Address
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Address Line | 2057 PULASKI HWY STE 4
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City | NORTH EAST
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State | MD
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Zip | 21901-3744
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Country | US
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Telephone | 443-877-4044
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | JANICE LESLIE FAIRCHILD CHAVERO
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Credential |
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Telephone | 443-877-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC2857
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License Number State | MD
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