Healthcare Provider Details

I. General information

NPI: 1851049753
Provider Name (Legal Business Name): FAMILY GUIDANCE OF VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WINDING CANYON DR
CHARLOTTE NC
28214-5011
US

IV. Provider business mailing address

220 WINDING CANYON DR
CHARLOTTE NC
28214-5011
US

V. Phone/Fax

Practice location:
  • Phone: 803-999-0476
  • Fax: 980-446-1340
Mailing address:
  • Phone: 803-999-0476
  • Fax: 980-446-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDERSON LANE
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA, BS, QP, CPSS
Phone: 803-999-0476