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General NPI Number Information
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NPI Number | 1093982282
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Entity Type | Organization
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Legal Business Name | EXTENDED FAMILIES OF N. C., LLC
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 400 S WATER ST SUITE 100
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-4965
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Country | US
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Telephone | 252-335-1478
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Fax | 252-335-2875
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Provider Business Mailing Address
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Address Line | PO BOX 2661
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City | ELIZABETH CITY
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State | NC
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Zip | 27906-2661
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Country | US
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Telephone | 252-335-1478
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Fax | 252-335-2875
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MS. CASSANDRA CLYDE HOUSTON
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Credential |
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Telephone | 252-335-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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