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General NPI Number Information
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NPI Number | 1235352717
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Entity Type | Organization
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Legal Business Name | FAMILY MENTAL HEALTH SERVICES, INC. OF RALEIGH. NC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 6129 REMINGTON LAKE DR
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City | RALEIGH
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State | NC
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Zip | 27616-6233
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Country | US
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Telephone | 919-875-1374
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Fax | 919-954-7051
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Provider Business Mailing Address
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Address Line | 6129 REMINGTON LAKE DR
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City | RALEIGH
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State | NC
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Zip | 27616-6233
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Country | US
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Telephone | 919-875-1374
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Fax | 919-954-7051
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Authorized Official
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Title or Position | DIRECTOR, OUT-PATIENT THERAPIST
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Name | MS. DOROTHY ANN GLASSE
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Credential | M.ED, MA, LPC, LCAS
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Telephone | 919-875-1374
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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 | 2365
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License Number State | NC
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