Healthcare Provider Details

I. General information

NPI: 1295812980
Provider Name (Legal Business Name): NIA CHILDREN AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 GREEN ST E
WILSON NC
27893-4176
US

IV. Provider business mailing address

504 GREEN ST E
WILSON NC
27893-4176
US

V. Phone/Fax

Practice location:
  • Phone: 252-291-5585
  • Fax: 252-291-1377
Mailing address:
  • Phone: 252-291-5585
  • Fax: 252-291-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004462
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier136X0
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS
# 2
Identifier6008112
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier6002748
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 4
Identifier8301730
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: PATRICIA TOWNSEND
Title or Position: OWNER/CLINICAL PROGRAM DIRECTOR
Credential: LCSW
Phone: 252-291-5585