Healthcare Provider Details

I. General information

NPI: 1003225491
Provider Name (Legal Business Name): JOHARI FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WHITFIELD ST
FAYETTEVILLE NC
28306-1617
US

IV. Provider business mailing address

511 MIDDLE RD
FAYETTEVILLE NC
28312-5207
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOY INNISS
Title or Position: CEO
Credential:
Phone: 910-897-3000