Provider Demographics
NPI:1588801336
Name:VALIANT FAMILIES, PC
Entity Type:Organization
Organization Name:VALIANT FAMILIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LARUE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:252-451-4451
Mailing Address - Street 1:1153 JEFFREYS RD
Mailing Address - Street 2:PO BOX 8064
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1866
Mailing Address - Country:US
Mailing Address - Phone:252-451-4451
Mailing Address - Fax:252-454-0009
Practice Address - Street 1:1153 JEFFREYS RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1866
Practice Address - Country:US
Practice Address - Phone:252-451-4451
Practice Address - Fax:252-454-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006423Medicaid