Provider Demographics
NPI:1295756484
Name:3-C FAMILY SERVICES, .P.A
Entity type:Organization
Organization Name:3-C FAMILY SERVICES, .P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:AZEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-677-0101
Mailing Address - Street 1:1901 N HARRISON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2410
Mailing Address - Country:US
Mailing Address - Phone:919-677-0101
Mailing Address - Fax:919-677-0113
Practice Address - Street 1:1901 N HARRISON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2410
Practice Address - Country:US
Practice Address - Phone:919-677-0101
Practice Address - Fax:919-677-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1700103TC0700X
NC0568103TC0700X
NC1920103TC0700X
NC3270103TC0700X
NC102679103TS0200X
NC2475103TS0200X
NCC0046701041C0700X
NC1067106H00000X
NC2001001312084P0800X
NC94003442084P0804X
NC9400342084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005218Medicaid