Healthcare Provider Details

I. General information

NPI: 1972944007
Provider Name (Legal Business Name): ADVANCED FAMILY STRATEGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 BURTONS CV
HAMPTON GA
30228-3185
US

IV. Provider business mailing address

3005 VILLAGE PARK DR STE 202
KNIGHTDALE NC
27545-7993
US

V. Phone/Fax

Practice location:
  • Phone: 919-217-0061
  • Fax:
Mailing address:
  • Phone: 919-217-0061
  • Fax: 919-217-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONETTA GRAHAM
Title or Position: DIRECTOR
Credential:
Phone: 919-217-0061