Provider Demographics
NPI:1467752907
Name:FAMILY RELATIONS & INTIMACY CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY RELATIONS & INTIMACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEVERS
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-258-8365
Mailing Address - Street 1:34 WALL ST
Mailing Address - Street 2:SUITE 803
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2725
Mailing Address - Country:US
Mailing Address - Phone:828-258-8365
Mailing Address - Fax:828-258-8365
Practice Address - Street 1:34 WALL ST
Practice Address - Street 2:SUITE 803
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2725
Practice Address - Country:US
Practice Address - Phone:828-258-8365
Practice Address - Fax:828-258-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000571Medicaid
NC11336736OtherCAQH
NC04602OtherBCBS
NC2819778Medicare PIN