Provider Demographics
NPI:1306554787
Name:FAISON, ALETHIA JEANETTE (MMFT)
Entity type:Individual
Prefix:
First Name:ALETHIA
Middle Name:JEANETTE
Last Name:FAISON
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 RIVERWATCH CT APT 6312
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1726
Mailing Address - Country:US
Mailing Address - Phone:804-943-1818
Mailing Address - Fax:
Practice Address - Street 1:1405 RIVERWATCH CT
Practice Address - Street 2:APT 6312
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128
Practice Address - Country:US
Practice Address - Phone:629-238-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN853459869Medicaid