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Individual
MRS. MARCIA ANNE FAIRBANKS
Active
Individual
MRS. MARCIA ANNE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
0904011395
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
06/28/2022
Last updated
06/28/2022
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