Organization
DR FAIRALL AND ASSOCIATES BEHAVIORAL HEALTH AND FAMILY MEDIATION SERVI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE FAIRALL PSY.D. (OWNER)
(904) 463-2284
Entity
Organization
Contact information
Practice address
4400 MARSH LANDING BLVD, SUITE 1, PONTE VEDRA BEACH, FL 32082-7215
(904) 463-2284
Mailing address
117 OLD MILL CT, PONTE VEDRA BEACH, FL 32082-4133
(904) 463-2284
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 7675
FL
Other
Enumeration date
11/30/2015
Last updated
11/30/2015
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