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Individual

MRS. ANITA ELLEN FADDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCAS-A

Contact information

Practice address
665 W. 4TH STREET, WINSTON SALEM, NC 27101
(336) 725-8389
(336) 725-1061
Mailing address
665 W. 4TH STREET, WINSTON SALEM, NC 27101
(336) 725-8389
(336) 725-1061

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NC

Other

Enumeration date
09/12/2012
Last updated
09/12/2012
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