Provider Demographics
NPI:1306085378
Name:FARDELLA, MAGGIE (LPC)
Entity type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:
Last Name:FARDELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-2229
Mailing Address - Country:US
Mailing Address - Phone:729-502-4000
Mailing Address - Fax:972-502-4001
Practice Address - Street 1:201 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:972-502-4019
Practice Address - Fax:972-502-4001
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional