Individual
MRS. DORIS STACY FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
501 SOUTH UNION AVE., HARFORD MEMORIAL HOSPITAL, HAVRE DE GRACE, MD 21078
(443) 843-8047
Mailing address
137 LINTON RUN ROAD, PORT DEPOSIT, MD 21904
(443) 907-8041
(410) 378-4162
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC8876
MD
101YP2500X
Professional Counselor
Primary
LC8876
MD
363A00000X
Physician Assistant
S0000060
MD
Other
Enumeration date
11/10/2014
Last updated
07/08/2019
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