Healthcare Provider Details

I. General information

NPI: 1376728832
Provider Name (Legal Business Name): FAMILY SERVICE OF THE PIEDMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 WHITE OAK ST # C
ASHEBORO NC
27203-4770
US

IV. Provider business mailing address

902 BONNER DR
JAMESTOWN NC
27282-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-1845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201930
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number201930
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1874
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041
License Number StateNC

VIII. Authorized Official

Name: MR. THOMAS F CAMPBELL
Title or Position: PRESIDENT AND CEO
Credential: LPC
Phone: 336-478-2017