Healthcare Provider Details

I. General information

NPI: 1629447685
Provider Name (Legal Business Name): 3-C FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HARRISON AVE SUITE 100
CARY NC
27513-2410
US

IV. Provider business mailing address

1901 N HARRISON AVE SUITE 100
CARY NC
27513-2410
US

V. Phone/Fax

Practice location:
  • Phone: 919-677-0101
  • Fax: 919-677-0113
Mailing address:
  • Phone: 919-677-0101
  • Fax: 919-677-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4838
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4838
License Number StateNC

VIII. Authorized Official

Name: DR. DON AZEVEDO
Title or Position: CLINIC DIRECTOR
Credential: PH.D.
Phone: 919-677-0101