Provider Demographics
NPI:1417089558
Name:FAMILY SERVICE AGENCY,INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-372-4242
Mailing Address - Street 1:628 W BROADWAY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5544
Mailing Address - Country:US
Mailing Address - Phone:501-372-4242
Mailing Address - Fax:501-372-6565
Practice Address - Street 1:628 W BROADWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5544
Practice Address - Country:US
Practice Address - Phone:501-372-4242
Practice Address - Fax:501-372-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health