Provider Demographics
NPI:1871672550
Name:FAMILY SERVICE OF THE PIEDMONT, INC
Entity Type:Organization
Organization Name:FAMILY SERVICE OF THE PIEDMONT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT.CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-889-6105
Mailing Address - Street 1:902 BONNER DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8948
Mailing Address - Country:US
Mailing Address - Phone:336-387-6161
Mailing Address - Fax:336-387-9167
Practice Address - Street 1:902 BONNER DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-8948
Practice Address - Country:US
Practice Address - Phone:336-387-6161
Practice Address - Fax:336-387-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1874101YA0400X
101YM0800X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005826Medicaid