Provider Demographics
NPI:1992318570
Name:THAYER, FAITH (LPC, LCAT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:LPC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5031
Mailing Address - Country:US
Mailing Address - Phone:203-982-0457
Mailing Address - Fax:
Practice Address - Street 1:209 S BROAD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5031
Practice Address - Country:US
Practice Address - Phone:203-982-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00667000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor