Provider Demographics
NPI:1528378221
Name:FAMILY OUTREACH AND COUNSELING CENTER
Entity Type:Organization
Organization Name:FAMILY OUTREACH AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:705-509-9917
Mailing Address - Street 1:200 W SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6650
Mailing Address - Country:US
Mailing Address - Phone:704-509-9917
Mailing Address - Fax:704-509-9945
Practice Address - Street 1:200 W SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6650
Practice Address - Country:US
Practice Address - Phone:704-509-9917
Practice Address - Fax:704-509-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0005101YS0200X
NC00026251300000X
CA050034753251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)