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Organization
MODERN MYSTICS, LLC
Active
Organization
MODERN MYSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON FAHY LCSW (FOUNDER/CEO)
(919) 839-9721
Entity
Organization
Contact information
Practice address
637 BARNESWYCK DR, FUQUAY VARINA, NC 27526-2277
(919) 839-9721
Mailing address
637 BARNESWYCK DR, FUQUAY VARINA, NC 27526-2277
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
175F00000X
Naturopath
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
03/21/2024
Last updated
03/21/2024
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