Healthcare Provider Details

I. General information

NPI: 1659510436
Provider Name (Legal Business Name): UNITED FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9624 BAILEY ROAD, SUITE 290
CORNELIUS NC
28031-6120
US

IV. Provider business mailing address

9624 BAILEY ROAD, SUITE 290
CORNELIUS NC
28031-6120
US

V. Phone/Fax

Practice location:
  • Phone: 704-655-8745
  • Fax: 704-655-0234
Mailing address:
  • Phone: 704-655-8745
  • Fax: 704-655-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN K JORDAN
Title or Position: VP, CLINICAL SERVICES
Credential: LCSW
Phone: 704-367-2750