Provider Demographics
NPI:1154844827
Name:FRY, EMILY VICTORIA (LPC-A, LCAS-A, NCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VICTORIA
Last Name:FRY
Suffix:
Gender:F
Credentials:LPC-A, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 OLD US 70 HWY W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6566
Mailing Address - Country:US
Mailing Address - Phone:919-359-1699
Mailing Address - Fax:919-359-1697
Practice Address - Street 1:1699 OLD US 70 HWY W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6566
Practice Address - Country:US
Practice Address - Phone:919-359-1699
Practice Address - Fax:919-359-1697
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23424101YA0400X
NCA13000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)