Provider Demographics
NPI:1801021597
Name:AB FAMILY SUPPORT CENTER
Entity Type:Organization
Organization Name:AB FAMILY SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-254-4858
Mailing Address - Street 1:81B CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2438
Mailing Address - Country:US
Mailing Address - Phone:828-254-4858
Mailing Address - Fax:828-254-4857
Practice Address - Street 1:81B CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2438
Practice Address - Country:US
Practice Address - Phone:828-254-4858
Practice Address - Fax:828-254-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NC2722-PSYCHOLOGIST261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006895Medicaid
2347901Medicare PIN