Healthcare Provider Details

I. General information

NPI: 1063754919
Provider Name (Legal Business Name): THOMPSON CHILD & FAMILY FOCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 FAYETTEVILLE RD
DURHAM NC
27713-6254
US

IV. Provider business mailing address

6800 SAINT PETERS LN
MATTHEWS NC
28105-8458
US

V. Phone/Fax

Practice location:
  • Phone: 919-294-6862
  • Fax: 919-294-9286
Mailing address:
  • Phone: 704-536-0375
  • Fax: 704-531-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MARY ELIZABETH PORRAS KANTROWITZ
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 704-536-0375