Provider Demographics
NPI:1134507973
Name:FAMILY ENRICHMENT CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY ENRICHMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESTON-JOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-472-4982
Mailing Address - Street 1:5505 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5252
Mailing Address - Country:US
Mailing Address - Phone:757-472-4982
Mailing Address - Fax:757-282-2909
Practice Address - Street 1:5505 INDIAN RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5252
Practice Address - Country:US
Practice Address - Phone:757-472-4982
Practice Address - Fax:757-282-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669702445Medicaid