Provider Demographics
NPI:1861784597
Name:FAIRLEY, DARLENE (LPC)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 WAGONER DR
Mailing Address - Street 2:SUITE 313
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4608
Mailing Address - Country:US
Mailing Address - Phone:910-273-0625
Mailing Address - Fax:910-568-3690
Practice Address - Street 1:351 WAGONER DR
Practice Address - Street 2:SUITE 313
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4608
Practice Address - Country:US
Practice Address - Phone:910-273-0625
Practice Address - Fax:910-568-3690
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional