MEDICARE: MRS. TAMIKA FAGAN CBCS, CCHT,NHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)		NC
2	103TC2200X	Clinical Child & Adolescent Psychologist	S4L8A5R7	NC
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		NC
4	376K00000X	Nurse's Aide		NC
5	251E00000X	Home Health Agency	1138009113	NC
6	261QU0200X	Urgent Care Clinic/Center		NC
7	251S00000X	Community/Behavioral Health Agency		NC
8	146D00000X	Personal Emergency Response Attendant	566993	NC
9	323P00000X	Psychiatric Residential Treatment Facility
10	343900000X	Non-emergency Medical Transport (VAN)		NC
11	385HR2055X	Child Mental Illness Respite Care		NC
12	385H00000X	Respite Care		NC
13	101YM0800X	Mental Health Counselor		NC
14	347E00000X	Transportation Broker		NC
15	171400000X	Health & Wellness Coach		NC

General Provider Information

NPI Number	:	1083587042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMIKA FAGAN CBCS, CCHT,NHA

Provider Business Mailing Address
First Line	:	1225 MANOR DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-4613
Country	:	US
Telephone Number	:	984-833-7423
Fax Number	:	252-316-8682

Provider Business Practice Location Address
First Line	:	1225 MANOR DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-4613
Country	:	US
Telephone Number	:	984-833-7423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	01/20/2026

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