Provider Demographics
NPI:1760675045
Name:FAMILY INTERVENTION & PREVENTION SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY INTERVENTION & PREVENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BA, MAT
Authorized Official - Phone:919-340-1626
Mailing Address - Street 1:211 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2565
Mailing Address - Country:US
Mailing Address - Phone:919-340-1626
Mailing Address - Fax:
Practice Address - Street 1:211 COURT ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2565
Practice Address - Country:US
Practice Address - Phone:919-340-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107400Medicaid