Provider Demographics
NPI:1700109014
Name:FAMILY WORKS PSCHYCOLOGICAL CENTER
Entity Type:Organization
Organization Name:FAMILY WORKS PSCHYCOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KASHGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-509-0588
Mailing Address - Street 1:603 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-592-1355
Mailing Address - Fax:910-592-0431
Practice Address - Street 1:2002 EASTWOOD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7218
Practice Address - Country:US
Practice Address - Phone:910-509-0588
Practice Address - Fax:910-509-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2550251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health