Orlesha Diane Fairgood, LICSW
Individual provider Active NPI Clinical Social Worker · Offutt Afb, NE
NPI 1689327082 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1689327082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 2257 (NE)
- Practice address
- 2501 Capehart Rd
Offutt Afb, NE 68113-1043 - Phone
- (402) 294-3206
- NPI assigned
- Jan 27, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1862 | NE | MD | Mental Health Counselor |
| 2257 | NE | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1862 | NE | |
| Clinical Social Worker | 1041C0700X | 2257 | NE | Yes |
Addresses
Primary practice location
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Mailing address
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Phone (402) 294-3206
Other providers in Offutt Afb, NE
- James Dreher
- Brian Edick
- Craig Daniel England
- John P Engler
- Anthony Charles Eschliman
- David Faith
- Daniel G Fender
- Edwin Fernandez Jr.
- Vivianle B Freeman
- William Freeman
All providers in Offutt Afb, NE · Clinical Social Worker in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.