Healthcare Provider Details

I. General information

NPI: 1750431318
Provider Name (Legal Business Name): FAMILY INTERVENTION & PREVENTION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARKVIEW DRIVE WEST SUITE A
HENDERSON NC
27536-2526
US

IV. Provider business mailing address

211 COURT ST
LOUISBURG NC
27549-2526
US

V. Phone/Fax

Practice location:
  • Phone: 252-572-2342
  • Fax: 252-572-2526
Mailing address:
  • Phone: 919-340-1626
  • Fax: 919-340-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-035-052
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS TANYA VICTORIA SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: MAT
Phone: 919-340-1626