Individual
ORLESHA DIANE FAIRGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-3206
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-3206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1862
NE
1041C0700X
Clinical Social Worker
Primary
2257
NE
Other
Enumeration date
01/27/2022
Last updated
01/27/2025
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