Healthcare Provider Details

I. General information

NPI: 1205327087
Provider Name (Legal Business Name): FAMILY FIRST CHOICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 VISTA DEL LAGO LANE
WAKE FOREST NC
27587
US

IV. Provider business mailing address

4801 GLENWOOD AVE STE 200
RALEIGH NC
27612-3857
US

V. Phone/Fax

Practice location:
  • Phone: 919-410-8169
  • Fax: 919-276-8635
Mailing address:
  • Phone: 919-410-8169
  • Fax: 919-276-8635

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LATISHA RILEY
Title or Position: COO
Credential: LCMHCS
Phone: 919-622-3931