Healthcare Provider Details

I. General information

NPI: 1134450877
Provider Name (Legal Business Name): FAMILY PRESERVATION SERVICES OF NC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOWARD GAP RD
FLETCHER NC
28732-9208
US

IV. Provider business mailing address

PO BOX 759194
BALTIMORE MD
21275-9194
US

V. Phone/Fax

Practice location:
  • Phone: 828-697-4187
  • Fax: 828-697-4488
Mailing address:
  • Phone: 828-225-3100
  • Fax: 828-225-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA KAYE LITTLE
Title or Position: NC QI & TRAINING DIR
Credential:
Phone: 704-344-0491