Healthcare Provider Details

I. General information

NPI: 1578090379
Provider Name (Legal Business Name): FAMILY CENTERED TREATMENT FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 THOMAS PAYNE CIR
CHARLOTTE NC
28277-8822
US

IV. Provider business mailing address

10140 THOMAS PAYNE CIR
CHARLOTTE NC
28277-8822
US

V. Phone/Fax

Practice location:
  • Phone: 704-787-6869
  • Fax: 888-316-9747
Mailing address:
  • Phone: 704-787-6869
  • Fax: 888-316-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIM WOOD
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 704-787-6869