Healthcare Provider Details

I. General information

NPI: 1528378221
Provider Name (Legal Business Name): FAMILY OUTREACH AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SUGAR CREEK RD
CHARLOTTE NC
28213-6650
US

IV. Provider business mailing address

200 W SUGAR CREEK RD
CHARLOTTE NC
28213-6650
US

V. Phone/Fax

Practice location:
  • Phone: 704-509-9917
  • Fax: 704-509-9945
Mailing address:
  • Phone: 704-509-9917
  • Fax: 704-509-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0005
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number00026
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number050034753
License Number StateCA

VIII. Authorized Official

Name: MRS. EDWINA ANNETTE DAVIES
Title or Position: COUNSELOR
Credential:
Phone: 705-509-9917