Healthcare Provider Details

I. General information

NPI: 1306073150
Provider Name (Legal Business Name): FAMILY OUTREACH & COUNSELING ,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARKWOOD AVE SUITE 204
CHARLOTTE NC
28205-2655
US

IV. Provider business mailing address

700 PARKWOOD AVE SUITE 204
CHARLOTTE NC
28205-2655
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-2033
  • Fax: 704-333-3639
Mailing address:
  • Phone: 704-333-2033
  • Fax: 704-333-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number306
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number306
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number306
License Number StateNC

VIII. Authorized Official

Name: MRS. DONA M. PATTERSON
Title or Position: EXECUTIVE DIRECTOR/PRESIDENT
Credential: LMFT,CSMS,CFAE
Phone: 704-333-2033