Provider Demographics
NPI:1205074325
Name:ATLANTIC FAMILY SERVICES LLC
Entity type:Organization
Organization Name:ATLANTIC FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LADONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TINNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-638-3354
Mailing Address - Street 1:1808 PENNYPACKER LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7974
Mailing Address - Country:US
Mailing Address - Phone:919-638-3354
Mailing Address - Fax:
Practice Address - Street 1:150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2808
Practice Address - Country:US
Practice Address - Phone:919-638-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health