Healthcare Provider Details

I. General information

NPI: 1902097132
Provider Name (Legal Business Name): FFC INSTITUTE FOR CHANGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
ROWLAND NC
28383
US

IV. Provider business mailing address

204 W MAIN ST
ROWLAND NC
28383
US

V. Phone/Fax

Practice location:
  • Phone: 910-422-8573
  • Fax:
Mailing address:
  • Phone: 910-422-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FONDA CLARK
Title or Position: PRESIDENT
Credential:
Phone: 910-422-8573