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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:

Details

NameValue
NPI1952672594
Enumeration Date2012-01-12
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)GA271261
No 101YM0800X - Counselor - Mental Health
Yes 101YP2500X - Counselor - ProfessionalGA005914