Provider Demographics
NPI:1407159601
Name:FAMILY PRESEVATION SERVICES OF NORTH CAROLINA
Entity Type:Organization
Organization Name:FAMILY PRESEVATION SERVICES OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTENSIVE IN-HOME TEAM LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:BEASLEY
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:P-LCSW
Authorized Official - Phone:828-287-6110
Mailing Address - Street 1:PO BOX 759194
Mailing Address - Street 2:BALTIMORE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:828-287-6110
Mailing Address - Fax:
Practice Address - Street 1:271A CALLAHAN KOON RD
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-2207
Practice Address - Country:US
Practice Address - Phone:828-287-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006199251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health