MEDICARE: INTEGRATED FAMILY SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1922372697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED FAMILY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 885
Second Line	:
City	:	AHOSKIE
State	:	NC
Zip	:	27910-0885
Country	:	US
Telephone Number	:	252-862-4411
Fax Number	:	252-862-4414

Provider Business Practice Location Address
First Line	:	9486 NC HWY 305
Second Line	:
City	:	JACKSON
State	:	NC
Zip	:	27845-9679
Country	:	US
Telephone Number	:	252-534-1088
Fax Number	:	252-534-1288

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	ANTHONY JEROME MANLEY-ROOK
Credential	:	LCSW
Telephone Number	:	252-439-0700

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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