Healthcare Provider Details

I. General information

NPI: 1073981817
Provider Name (Legal Business Name): PINNACLE FAMILY SERVICES OF NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N MAIN ST
TROY NC
27371-3018
US

IV. Provider business mailing address

3125 POPLARWOOD CT STE 300
RALEIGH NC
27604-6445
US

V. Phone/Fax

Practice location:
  • Phone: 910-576-1188
  • Fax:
Mailing address:
  • Phone: 919-790-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PRESTON SCOTT MARTIN
Title or Position: CEO
Credential:
Phone: 919-790-8580