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General NPI Number Information
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NPI Number | 1427586700
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Entity Type | Organization
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Legal Business Name | FAMILY BEHAVIORAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1528 UNION RD
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City | GASTONIA
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State | NC
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Zip | 28054-2200
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Country | US
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Telephone | 704-995-4724
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Fax | 704-864-1476
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Provider Business Mailing Address
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Address Line | 1528 UNION RD
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City | GASTONIA
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State | NC
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Zip | 28054-2200
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Country | US
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Telephone | 704-995-4724
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Fax | 704-864-1476
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Authorized Official
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Title or Position | CEO
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Name | HOLLY SHIVADECKER
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Credential |
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Telephone | 704-995-4724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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