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General NPI Number Information
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NPI Number | 1487955589
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Entity Type | Individual
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Provider Name | NICOLE EVE FAYARD LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2010
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 19662 WOOTTON AVE SUITE 203
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City | POOLESVILLE
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State | MD
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Zip | 20837-3003
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Country | US
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Telephone | 240-271-7689
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Fax |
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Provider Business Mailing Address
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Address Line | 19662 WOOTTON AVE SUITE 203
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City | POOLESVILLE
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State | MD
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Zip | 20837-3003
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Country | US
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Telephone | 240-271-7689
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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 | LC3474
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License Number State | MD
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