| Connie M Fairchild Ma Lpc Cac I | |
|
315 E Dale St Colorado Springs CO 80903-1102 | |
| (719) 291-5623 | |
| (719) 473-4066 |
| Full Name | Connie M Fairchild Ma Lpc Cac I |
|---|---|
| Speciality | Counselor - Professional |
| Location | 315 E Dale St, Colorado Springs, Colorado |
| Authorized Official Name and Position | Connie M Fairchild (PRESIDENT SINGLE ENTITY LLC) |
| Authorized Official Contact | 7192915623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Connie M Fairchild Ma Lpc Cac I Po Box 2687 Colorado Springs CO 80901-2687 Ph: (719) 291-5623 | Connie M Fairchild Ma Lpc Cac I 315 E Dale St Colorado Springs CO 80903-1102 Ph: (719) 291-5623 |
| NPI Number | 1952516338 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 09/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952516338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 5708 (Colorado) | Secondary |
| 101YP2500X | Counselor - Professional | 1385 (Colorado) | Primary |
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