Provider Demographics
| NPI: | 1063488773 |
|---|---|
| Name: | FAMILY WORKS PSYCHOLOGICAL CENTER |
| Entity Type: | Organization |
| Organization Name: | FAMILY WORKS PSYCHOLOGICAL CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | GUY |
| Authorized Official - Middle Name: | TOREN |
| Authorized Official - Last Name: | KASHGARIAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD |
| Authorized Official - Phone: | 910-231-3761 |
| Mailing Address - Street 1: | 2002 EASTWOOD ROAD |
| Mailing Address - Street 2: | SUITE 303 |
| Mailing Address - City: | WILMINGTON |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28403 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 910-231-3761 |
| Mailing Address - Fax: | 910-509-0586 |
| Practice Address - Street 1: | 2002 EASTWOOD ROAD |
| Practice Address - Street 2: | SUITE 303 |
| Practice Address - City: | WILMINGTON |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28403 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 910-509-0588 |
| Practice Address - Fax: | 910-509-0586 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-02-23 |
| Last Update Date: | 2023-12-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | 101Y00000X, 103T00000X, 103TB0200X, 103TF0000X, 103TS0200X, 104100000X, 1041C0700X, 106H00000X, 2084P0800X, 261QM0850X | |
| NC | 4219 | 101YM0800X |
| NC | 2612 | 103T00000X, 103TC2200X |
| NC | 2550 | 103TC0700X |
| NC | 100464 | 363A00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 6006920 | Medicaid | |
| NC | 607006600 | Other | US DEPT OF LABOR |
| NC | 5906686 | Medicaid | |
| NC | 5914700 | Medicaid | |
| NC | 6005231 | Medicaid | |
| NC | 015EA | Other | BCBS |
| NC | 5913436 | Medicaid | |
| NC | 6005196 | Medicaid | |
| NC | 6005231 | Medicaid |
