Provider Demographics
NPI:1003123795
Name:MID-SOUTH FAMILY SERVICES
Entity Type:Organization
Organization Name:MID-SOUTH FAMILY SERVICES
Other - Org Name:MID-SOUTH FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-541-4816
Mailing Address - Street 1:700 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:757-541-4816
Mailing Address - Fax:
Practice Address - Street 1:700 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2220
Practice Address - Country:US
Practice Address - Phone:757-541-4816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health