Provider Information for 1952672594
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Mr. FRED MATTHEW FARRAR LPC , NCC
Sex: Male
NPI: 1952672594
Last Updated: 2012-01-12
Certification Date:
Certification Date:
Details
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NPI | 1952672594 | ||||||||||||||||
Enumeration Date | 2012-01-12 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | YES | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | PO BOX 4078 LAGRANGE, GA 30241-0082 United States Phone: 706-837-0045 | Fax:706-837-0035 | ||||||||||||||||
Primary Practice Address | 98 GORDON COMMERCIAL DR LAGRANGE, GA 30240-5735 United States Phone: 706-837-0045 | Fax:706-837-0035 | ||||||||||||||||
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