Individual
MR. JERRY FATICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPA
Contact information
Practice address
1703 COUNTRY CLUB ROAD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Mailing address
1703 COUNTRY CLUB ROAD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1096
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141GP
BC/BS
NC
05
—
6107096
—
NC
Enumeration date
12/16/2005
Last updated
05/08/2008
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