Healthcare Provider Details

I. General information

NPI: 1275769200
Provider Name (Legal Business Name): FAMILIES 1ST COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 WAGONER DR SUITE 106
FAYETTEVILLE NC
28303-4680
US

IV. Provider business mailing address

346 WAGONER DR SUITE 106
FAYETTEVILLE NC
28303-4680
US

V. Phone/Fax

Practice location:
  • Phone: 910-864-0179
  • Fax: 910-864-3162
Mailing address:
  • Phone: 910-864-0179
  • Fax: 910-864-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7255
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7255
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1596
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number7255
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number7255
License Number StateNC

VIII. Authorized Official

Name: MRS. TOMEKA DAVIS SHAW
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: LPC, NCC
Phone: 910-797-5661