Healthcare Provider Details

I. General information

NPI: 1932439460
Provider Name (Legal Business Name): UNITED FAMILY NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 KENNEBEC RD
WILLOW SPRING NC
27592-9417
US

IV. Provider business mailing address

9609 KENNEBEC RD
WILLOW SPRING NC
27592-9417
US

V. Phone/Fax

Practice location:
  • Phone: 919-749-2767
  • Fax: 919-567-1325
Mailing address:
  • Phone: 919-749-2767
  • Fax: 919-567-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. CHRIS SIMMONS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-749-2767