Provider Demographics
NPI:1093356875
Name:INDIVIDUAL/FAMILY ASSESSMENT AND TREATMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:INDIVIDUAL/FAMILY ASSESSMENT AND TREATMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-280-6513
Mailing Address - Street 1:2005 BOULEVARD ST STE E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4557
Mailing Address - Country:US
Mailing Address - Phone:910-280-6513
Mailing Address - Fax:
Practice Address - Street 1:2005 BOULEVARD ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4557
Practice Address - Country:US
Practice Address - Phone:910-280-6513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC001549Medicaid