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General NPI Number Information
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NPI Number | 1376728832
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICE OF THE PIEDMONT
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 513 WHITE OAK ST # C
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City | ASHEBORO
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State | NC
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Zip | 27203-4770
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Country | US
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Telephone | 336-633-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 902 BONNER DR
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City | JAMESTOWN
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State | NC
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Zip | 27282-8948
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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 | PRESIDENT AND CEO
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Name | MR. THOMAS F CAMPBELL
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Credential | LPC
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Telephone | 336-478-2017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1874
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201930
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 201930
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1041
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License Number State | NC
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