Individual
MS. MARY ANN THERESA FABRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADCII
Contact information
Practice address
105 W Q ST STE 5, SPRINGFIELD, OR 97477-2188
(541) 510-2548
(541) 741-0522
Mailing address
PO BOX 1962, 105 W Q STREET #5 SPRINGFIELD, OR 97477, EUGENE, OR 97440-1962
(541) 510-2548
(541) 741-0522
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01-07-79
OR
Other
Enumeration date
10/27/2015
Last updated
10/27/2015
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