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General NPI Number Information
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NPI Number | 1598717472
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICE INC.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 214 E. FRANKLIN BLVD
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City | GASTONIA
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State | NC
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Zip | 28052
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Country | US
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Telephone | 704-864-7704
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Fax | 704-862-0239
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Provider Business Mailing Address
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Address Line | 214 E. FRANKLIN BLVD
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City | GASTONIA
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State | NC
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Zip | 28052
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Country | US
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Telephone | 704-864-7704
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Fax | 704-862-0239
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PHILIP JOSEPH DELUCA
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Credential | MSW
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Telephone | 704-864-7704
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3588
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3726
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6682
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C000132
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License Number State | NC
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