Provider Demographics
NPI:1164216578
Name:MAYA FARFAN, GRETEL STEPHANIE (LCMHC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:STEPHANIE
Last Name:MAYA FARFAN
Suffix:
Gender:F
Credentials:LCMHC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MISSION OAKS ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-7822
Mailing Address - Country:US
Mailing Address - Phone:704-298-9104
Mailing Address - Fax:
Practice Address - Street 1:7215 LEBANON RD STE C
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9027
Practice Address - Country:US
Practice Address - Phone:980-403-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21261101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor