=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730220369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FS I SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 E BESSEMER AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-542-2076
-----------------------------------------------------
Fax | 336-272-1182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 E BESSEMER AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-542-2076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHERYL KETNER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 336-542-2076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------