Healthcare Provider Details

I. General information

NPI: 1912133489
Provider Name (Legal Business Name): PIEDMONT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GATEWAY BLVD SUITE 207
MOORESVILLE NC
28117-5596
US

IV. Provider business mailing address

PO BOX 1297
SHELBY NC
28151-1297
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-1175
  • Fax: 704-664-1193
Mailing address:
  • Phone: 704-482-2460
  • Fax: 704-487-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2005-00391
License Number StateNC

VIII. Authorized Official

Name: JANET S ECKARD
Title or Position: PARTNER/BUSINESS MANAGER
Credential:
Phone: 704-482-2460