Provider Demographics
NPI:1619206000
Name:A FAMILY'S POTENTIAL COUNSELING SERVICE, PLLC
Entity Type:Organization
Organization Name:A FAMILY'S POTENTIAL COUNSELING SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:YAREM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-434-3064
Mailing Address - Street 1:2329 BRASSTOWN LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 US HIGHWAY 70 E
Practice Address - Street 2:SUITE 130
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4071
Practice Address - Country:US
Practice Address - Phone:919-772-9371
Practice Address - Fax:919-779-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007261Medicaid