Provider Demographics
NPI:1154804730
Name:FAGGART, RIA JAKYRA
Entity type:Individual
Prefix:
First Name:RIA
Middle Name:JAKYRA
Last Name:FAGGART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 AMHURST ST SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-8802
Mailing Address - Country:US
Mailing Address - Phone:980-777-4111
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7230
Practice Address - Country:US
Practice Address - Phone:980-777-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty