Provider Demographics
NPI:1629542543
Name:FAMILY FIRST SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY FIRST SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LETESHA
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-678-6000
Mailing Address - Street 1:111 CHARLESTON PL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6125
Mailing Address - Country:US
Mailing Address - Phone:252-678-6000
Mailing Address - Fax:
Practice Address - Street 1:111 CHARLESTON PL
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6125
Practice Address - Country:US
Practice Address - Phone:252-678-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FIRST SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103918Medicaid