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General NPI Number Information
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NPI Number | 1518267004
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICE FOR ADULT AND CHILDREN,LLC
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 10/30/2010
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Provider Practice Location Address
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Address Line | 2841 DAISY LN N D
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City | WILSON
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State | NC
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Zip | 27896-6948
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Country | US
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Telephone | 252-991-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 2841 DAISY LN N D
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City | WILSON
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State | NC
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Zip | 27896-6948
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Country | US
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Telephone | 252-991-2160
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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 | MISS YANET FERNANDEZ
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Credential | BA
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Telephone | 252-991-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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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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