Provider Demographics
NPI:1104185115
Name:CHILD & FAMILY SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:CHILD & FAMILY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-257-7394
Mailing Address - Street 1:3300 ONYX RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2821
Mailing Address - Country:US
Mailing Address - Phone:954-257-7394
Mailing Address - Fax:919-400-4210
Practice Address - Street 1:2921 GROSS AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6496
Practice Address - Country:US
Practice Address - Phone:954-257-7394
Practice Address - Fax:919-400-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health