Provider Demographics
NPI:1235352717
Name:FAMILY MENTAL HEALTH SERVICES, INC. OF RALEIGH. NC
Entity Type:Organization
Organization Name:FAMILY MENTAL HEALTH SERVICES, INC. OF RALEIGH. NC
Other - Org Name:DOROTHY A. GLASSE, M. ED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, OUT-PATIENT THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MA, LPC, LCAS
Authorized Official - Phone:919-875-1374
Mailing Address - Street 1:6129 REMINGTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6233
Mailing Address - Country:US
Mailing Address - Phone:919-875-1374
Mailing Address - Fax:919-954-7051
Practice Address - Street 1:6129 REMINGTON LAKE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6233
Practice Address - Country:US
Practice Address - Phone:919-875-1374
Practice Address - Fax:919-954-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141VTOtherINDEPENDENT MENTAL HEALTH
NC8268OtherPREFERRED PROVIDER
NC6102252Medicaid