MEDICARE: FAMILY PRESERVATION SERVICES OF NC, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	106H00000X	Marriage & Family Therapist
6	103T00000X	Psychologist
7	103TA0400X	Addiction (Substance Use Disorder) Psychologist
8	103TC0700X	Clinical Psychologist
9	103TC2200X	Clinical Child & Adolescent Psychologist
10	103TC1900X	Counseling Psychologist
11	104100000X	Social Worker
12	1041C0700X	Clinical Social Worker
13	1041S0200X	School Social Worker
14	103TS0200X	School Psychologist
15	251S00000X	Community/Behavioral Health Agency

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1265570246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRESERVATION SERVICES OF NC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 759194
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-9194
Country	:	US
Telephone Number	:	828-225-3100
Fax Number	:	828-225-3604

Provider Business Practice Location Address
First Line	:	941 W ANDREWS AVE STE I
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2586
Country	:	US
Telephone Number	:	252-438-4740
Fax Number	:

Authorized Official
Title or Position	:	NC QI & TRAINING DIR
Name	:	MIRANDA KAYE LITTLE
Credential	:
Telephone Number	:	704-344-0491

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/11/2014