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General NPI Number Information
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NPI Number | 1548376296
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Entity Type | Individual
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Provider Name | WANDA C. FAURIE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 675 SEMINOLE AVE NE SUITE 108
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City | ATLANTA
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State | GA
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Zip | 30307-3408
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Country | US
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Telephone | 770-486-9660
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Fax | 855-344-7918
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Provider Business Mailing Address
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Address Line | 675 SEMINOLE AVE NE SUITE 108
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City | ATLANTA
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State | GA
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Zip | 30307-3408
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Country | US
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Telephone | 770-486-9660
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Fax | 855-344-7918
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001538
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License Number State | GA
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