MEDICARE: FAMILY FIRST COMMUNITY SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP2500X	Professional Counselor
4	103TC0700X	Clinical Psychologist
5	1041C0700X	Clinical Social Worker
6	106H00000X	Marriage & Family Therapist
7	2084P0800X	Psychiatry Physician
8	261Q00000X	Clinic/Center
9	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
10	261QM0850X	Adult Mental Health Clinic/Center
11	363A00000X	Physician Assistant
12	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
13	251S00000X	Community/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1780871293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST COMMUNITY SERVICES, LLC

Provider Business Mailing Address
First Line	:	3705 LATROBE DR
Second Line	:	SUITE 340
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4824
Country	:	US
Telephone Number	:	704-364-3989
Fax Number	:	704-364-3974

Provider Business Practice Location Address
First Line	:	3705 LATROBE DR
Second Line	:	SUITE 340
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4824
Country	:	US
Telephone Number	:	704-364-3989
Fax Number	:	704-364-3974

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MICHIKO K DOWDY
Credential	:	BSW
Telephone Number	:	704-364-3989

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	02/02/2023

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