Provider Demographics
NPI:1174138648
Name:FASICK, BARBARA AILEEN (QMHP-A)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:AILEEN
Last Name:FASICK
Suffix:
Gender:F
Credentials:QMHP-A
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:AILEEN
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1304
Mailing Address - Country:US
Mailing Address - Phone:540-482-0164
Mailing Address - Fax:540-264-3096
Practice Address - Street 1:20 W COURT ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1304
Practice Address - Country:US
Practice Address - Phone:540-482-0164
Practice Address - Fax:540-264-3096
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker