Provider Demographics
NPI:1033239223
Name:INTEGRATED FAMILY SERVICES, PLLC
Entity Type:Organization
Organization Name:INTEGRATED FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLEY-ROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-862-4411
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1114
Mailing Address - Country:US
Mailing Address - Phone:252-862-4411
Mailing Address - Fax:252-862-4414
Practice Address - Street 1:2000 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1723
Practice Address - Country:US
Practice Address - Phone:252-862-4411
Practice Address - Fax:252-862-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300566Medicaid