Individual
DOUGLAS FAXON, JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
7657 GILBERT ST, PHILADELPHIA, PA 19150-2605
(267) 978-1664
Mailing address
7657 GILBERT ST, PHILADELPHIA, PA 19150-2605
(267) 978-1664
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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