Healthcare Provider Details

I. General information

NPI: 1235402884
Provider Name (Legal Business Name): INTEGRATED FAMILY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E VICTORIA CT SUITE A
GREENVILLE NC
27858-5755
US

IV. Provider business mailing address

PO BOX 885
AHOSKIE NC
27910-0885
US

V. Phone/Fax

Practice location:
  • Phone: 252-439-0700
  • Fax: 252-439-0900
Mailing address:
  • Phone: 252-862-4411
  • Fax: 252-862-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY JEROME MANLEY-ROOK
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: LCSW
Phone: 252-439-0700