Individual
LACEY FAUGHENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
161 HIGH ST SE STE 202, SALEM, OR 97301-3610
(503) 902-5930
(503) 917-5991
Mailing address
PO BOX 831, JEFFERSON, OR 97352-0831
(503) 902-5930
(503) 917-5991
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
L7417
OR
1041C0700X
Clinical Social Worker
Primary
L7417
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500685336
—
OR
Enumeration date
07/15/2014
Last updated
06/06/2022
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