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General NPI Number Information
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NPI Number | 1083061345
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 115 W 2ND AVE
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City | FRANKLIN
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State | VA
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Zip | 23851-1711
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Country | US
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Telephone | 757-562-2108
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Fax | 757-562-2109
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Provider Business Mailing Address
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Address Line | PO BOX 1854
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-0854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | COREY OLDS
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Credential |
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Telephone | 757-879-4324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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