Healthcare Provider Details

I. General information

NPI: 1740597608
Provider Name (Legal Business Name): FACT SPECIALIZED SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CENTER ST
JACKSONVILLE NC
28546-5708
US

IV. Provider business mailing address

127 CENTER ST
JACKSONVILLE NC
28546-5708
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-3744
  • Fax: 910-346-5344
Mailing address:
  • Phone: 910-346-3744
  • Fax: 910-346-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2112
License Number StateNC

VIII. Authorized Official

Name: LORNA KATHLEEN ASCHBRENNER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 910-346-3744