Provider Demographics
NPI:1962816884
Name:FAMILY PRESERVATION SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VA STATE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-710-6085
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:5123 & 5127 DICKENSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-963-3606
Practice Address - Fax:276-963-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA158 02 014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA158 02 014Medicaid