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General NPI Number Information
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NPI Number | 1316225501
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Entity Type | Organization
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Legal Business Name | FERNANDEZ FAMILIA CLINIC
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | 312 W MILLBROOK RD STE 121
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City | RALEIGH
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State | NC
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Zip | 27609-4398
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Country | US
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Telephone | 919-926-7503
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Fax |
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Provider Business Mailing Address
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Address Line | 312 W MILLBROOK RD SUITE 121
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-926-7503
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Fax |
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Authorized Official
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Title or Position | EXCUTIVE DIRECTOR
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Name | MS. YANET FERNANDEZ
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Credential |
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Telephone | 646-244-9931
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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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Taxonomy #2
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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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