Provider Demographics
NPI:1942289244
Name:INTEGRATED FAMILY SERVICES PLLC
Entity Type:Organization
Organization Name:INTEGRATED FAMILY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-439-0700
Mailing Address - Street 1:P O BOX 885
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0885
Mailing Address - Country:US
Mailing Address - Phone:252-209-0388
Mailing Address - Fax:252-209-0422
Practice Address - Street 1:202 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-9743
Practice Address - Country:US
Practice Address - Phone:252-209-0388
Practice Address - Fax:252-209-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00035071041C0700X
175T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0007765688OtherAETNA
NC1385NOtherBCBSNC
NC6005390Medicaid
NC=========OtherCIGNA BEHAVIORAL HEALTH