Healthcare Provider Details

I. General information

NPI: 1265769178
Provider Name (Legal Business Name): FAMILY 1ST PARTNERSHIPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BRIAR CREEK RD SUITE AA 412
CHARLOTTE NC
28205-6903
US

IV. Provider business mailing address

800 BRIAR CREEK RD SUITE AA 412
CHARLOTTE NC
28205-6903
US

V. Phone/Fax

Practice location:
  • Phone: 704-631-9937
  • Fax: 866-311-4280
Mailing address:
  • Phone: 704-631-9937
  • Fax: 704-248-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KESHIA DUNN ROSS
Title or Position: PRESIDENT/CEO
Credential: LPC, LCAS, NCC, CSI
Phone: 704-619-9290