Active NPI
Nicole Eve Fayard, LCPC
- Counselor
- Poolesville, MD
National Provider Identifier
1487955589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LC3474
- Practice address
- 19662 Wootton Ave
Suite 203
Poolesville, MD 20837-3003 - Phone
- (240) 271-7689
- NPI assigned
- Nov 6, 2010
- Last updated
- May 3, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LC3474 | MD | Primary |
Addresses
Primary practice location
19662 Wootton Ave
Suite 203
Poolesville, MD 20837-3003
Mailing address
19662 Wootton Ave
Suite 203
Poolesville, MD 20837-3003
Phone (240) 271-7689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 17, 2025 through Apr 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC3474 | MD | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1487955589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19662 WOOTTON AVE",
"address_2": "SUITE 203",
"city": "POOLESVILLE",
"state": "MD",
"postal_code": "208373003",
"telephone_number": "240-271-7689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19662 WOOTTON AVE",
"address_2": "SUITE 203",
"city": "POOLESVILLE",
"state": "MD",
"postal_code": "208373003",
"telephone_number": "240-271-7689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYARD",
"first_name": "NICOLE",
"middle_name": "EVE",
"name_prefix": "Mrs.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-06",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MD",
"license": "LC3474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poolesville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.