Provider Demographics
NPI:1487955589
Name:FAYARD, NICOLE EVE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:EVE
Last Name:FAYARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19662 WOOTTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-3003
Mailing Address - Country:US
Mailing Address - Phone:240-271-7689
Mailing Address - Fax:
Practice Address - Street 1:19662 WOOTTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-3003
Practice Address - Country:US
Practice Address - Phone:240-271-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-06
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3474101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor