Healthcare Provider Details

I. General information

NPI: 1033239223
Provider Name (Legal Business Name): INTEGRATED FAMILY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NASH ST N
WILSON NC
27893-1723
US

IV. Provider business mailing address

PO BOX 8114
WILSON NC
27893-1114
US

V. Phone/Fax

Practice location:
  • Phone: 252-862-4411
  • Fax: 252-862-4414
Mailing address:
  • Phone: 252-862-4411
  • Fax: 252-862-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier8300566
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MR. ANTHONY MANLEY-ROOK
Title or Position: ADMINSTRATIVE DIRECTOR
Credential: LCSW
Phone: 252-862-4411