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General NPI Number Information
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NPI Number | 1609691757
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Entity Type | Organization
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Legal Business Name | FORGED BY FIRE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1532 VANDENBERG DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-7639
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Country | US
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Telephone | 472-208-7904
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 VANDENBERG DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-7639
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Country | US
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Telephone | 472-208-7904
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MARY LYNN CAMPBELL
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Credential | LCAS 30162
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Telephone | 472-208-7904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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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 | 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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