Healthcare Provider Details

I. General information

NPI: 1487805321
Provider Name (Legal Business Name): ASSOCIATED FAMILY AND LIFE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 PAGE RD SUITE 204
DURHAM NC
27703-5952
US

IV. Provider business mailing address

2144 PAGE RD SUITE 204
DURHAM NC
27703-5952
US

V. Phone/Fax

Practice location:
  • Phone: 919-797-2507
  • Fax: 919-908-8207
Mailing address:
  • Phone: 919-797-2507
  • Fax: 919-908-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. WINSTON VICKERS
Title or Position: DIRECTOR
Credential: BSBA
Phone: 919-724-9157