Basic Information
| Provider Information | |||||||||
| NPI: | 1407159601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PRESEVATION SERVICES OF NORTH CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 759194 | ||||||||
| Address2: | BALTIMORE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212759194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282876110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 271A CALLAHAN KOON RD | ||||||||
| Address2: | |||||||||
| City: | SPINDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281602207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282876110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 12/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | WADE | ||||||||
| AuthorizedOfficialMiddleName: | BEASLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | INTENSIVE IN-HOME TEAM LEADER | ||||||||
| AuthorizedOfficialTelephone: | 8282876110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P-LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | P006199 | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.