MEDICARE: MRS. DARBY M FALLON LPCA

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	101YP2500X	Professional Counselor	A8677	NC

General Provider Information

NPI Number	:	1184999153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARBY M FALLON LPCA

Provider Business Mailing Address
First Line	:	1010 1ST ST
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-8620
Country	:	US
Telephone Number	:	850-980-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3806 PARK AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6738
Country	:	US
Telephone Number	:	910-392-0477
Fax Number	:	910-392-0477

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

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/22/2012

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