Provider Demographics
NPI:1093193310
Name:FAMILY PSYCHIATRIC SOLUTIONS
Entity Type:Organization
Organization Name:FAMILY PSYCHIATRIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:QIONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNEY RAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-342-8870
Mailing Address - Street 1:5318 HIGHGATE DR STE 132
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6631
Mailing Address - Country:US
Mailing Address - Phone:919-342-8870
Mailing Address - Fax:
Practice Address - Street 1:5318 HIGHGATE DR STE 132
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6631
Practice Address - Country:US
Practice Address - Phone:919-342-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01400261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093933863OtherNPI