Provider Demographics
NPI:1275580136
Name:FAMILY COUNSELING SERVICE OF DURHAM
Entity Type:Organization
Organization Name:FAMILY COUNSELING SERVICE OF DURHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-416-4400
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:SUITE 6662
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:SUITE 6662
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1115
Practice Address - Country:US
Practice Address - Phone:919-598-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003809Medicaid
NC6003809Medicaid