Provider Demographics
NPI:1710384565
Name:FAMILY CARE PRACTICE, PLLC
Entity Type:Organization
Organization Name:FAMILY CARE PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENI
Authorized Official - Middle Name:
Authorized Official - Last Name:VILCA-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:252-412-4829
Mailing Address - Street 1:1310 E ARLINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9976
Mailing Address - Country:US
Mailing Address - Phone:252-412-4829
Mailing Address - Fax:
Practice Address - Street 1:1310 E ARLINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9976
Practice Address - Country:US
Practice Address - Phone:252-412-4829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1566251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821334285Medicaid