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General NPI Number Information
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NPI Number | 1487948600
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Entity Type | Organization
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Legal Business Name | FAMILY COUNSELING CENTER
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 301 MEDICAL PARK DR SUITE 202-B
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City | CONCORD
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State | NC
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Zip | 28025-2981
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Country | US
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Telephone | 704-403-2692
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MEDICAL PARK DR SUITE 202-B
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City | CONCORD
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State | NC
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Zip | 28025-2981
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Country | US
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Telephone | 704-403-2692
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORK
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Name | KIMBER MORK
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Credential | LCSW
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Telephone | 704-403-2692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004859
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License Number State | NC
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