Provider Demographics
NPI:1962221051
Name:FAGGART, JAILAH
Entity type:Individual
Prefix:
First Name:JAILAH
Middle Name:
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 1:855 GOLD HILL RD # 1010
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7977
Mailing Address - Country:US
Mailing Address - Phone:704-584-9666
Mailing Address - Fax:
Practice Address - Street 1:855 GOLD HILL RD # 1010
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7977
Practice Address - Country:US
Practice Address - Phone:704-584-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional