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General NPI Number Information
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NPI Number | 1952516338
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Entity Type | Organization
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Legal Business Name | FAIRCHILD COUNSELING LLC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 315 E DALE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1102
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Country | US
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Telephone | 719-291-5623
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Fax | 719-473-4066
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Provider Business Mailing Address
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Address Line | PO BOX 2687
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-2687
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Country | US
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Telephone | 719-291-5623
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Fax | 719-473-4066
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Authorized Official
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Title or Position | PRESIDENT SINGLE ENTITY LLC
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Name | MS. CONNIE M FAIRCHILD
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Credential | MA LPC CAC I
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Telephone | 719-291-5623
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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 | 5708
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1385
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License Number State | CO
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