Provider Demographics
NPI:1518267004
Name:FAMILY SERVICE FOR ADULT AND CHILDREN,LLC
Entity Type:Organization
Organization Name:FAMILY SERVICE FOR ADULT AND CHILDREN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:252-991-2160
Mailing Address - Street 1:2841 DAISY LN N
Mailing Address - Street 2:D
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-6948
Mailing Address - Country:US
Mailing Address - Phone:252-991-2160
Mailing Address - Fax:
Practice Address - Street 1:2841 DAISY LN N
Practice Address - Street 2:D
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-6948
Practice Address - Country:US
Practice Address - Phone:252-991-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty