Healthcare Provider Details

I. General information

NPI: 1558599316
Provider Name (Legal Business Name): FAMILY PRESERVATION SERVICES OF NC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271A CALLAHAN KOON RD
SPINDALE NC
28160-2207
US

IV. Provider business mailing address

PO BOX 759194
BALTIMORE MD
21275-9194
US

V. Phone/Fax

Practice location:
  • Phone: 828-287-6110
  • Fax: 828-287-6092
Mailing address:
  • Phone: 540-710-6085
  • Fax: 540-710-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA KAYE LITTLE
Title or Position: NC QI & TRAINING DIR
Credential:
Phone: 704-344-0491