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General NPI Number Information
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NPI Number | 1275769200
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Entity Type | Organization
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Legal Business Name | FAMILIES 1ST COUNSELING, PLLC
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 346 WAGONER DR SUITE 106
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4680
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Country | US
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Telephone | 910-864-0179
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Fax | 910-864-3162
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Provider Business Mailing Address
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Address Line | 346 WAGONER DR SUITE 106
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4680
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Country | US
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Telephone | 910-864-0179
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Fax | 910-864-3162
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | MRS. TOMEKA DAVIS SHAW
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Credential | LPC, NCC
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Telephone | 910-797-5661
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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 | 7255
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 7255
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7255
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1596
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7255
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License Number State | NC
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