Provider Demographics
NPI:1295812980
Name:NIA CHILDREN AND FAMILY SERVICES
Entity type:Organization
Organization Name:NIA CHILDREN AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-291-5585
Mailing Address - Street 1:504 GREEN ST E
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4176
Mailing Address - Country:US
Mailing Address - Phone:252-291-5585
Mailing Address - Fax:252-291-1377
Practice Address - Street 1:504 GREEN ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4176
Practice Address - Country:US
Practice Address - Phone:252-291-5585
Practice Address - Fax:252-291-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044621041C0700X
NC251S00000X
101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136X0OtherBCBS
NC6008112Medicaid
NC6002748Medicaid
NC8301730Medicaid
NC6002748Medicaid