Healthcare Provider Details

I. General information

NPI: 1043453798
Provider Name (Legal Business Name): FAMILY UNITED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 WIND CHIME CT STE 204
RALEIGH NC
27615-6478
US

IV. Provider business mailing address

PO BOX 38568
CHARLOTTE NC
28278-1009
US

V. Phone/Fax

Practice location:
  • Phone: 980-230-3072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN CANTY
Title or Position: OWNER
Credential:
Phone: 980-230-3072