Provider Demographics
NPI:1700955242
Name:THE FAMILY LIFE CENTER OF ROCKINGHAM CO. INC.
Entity Type:Organization
Organization Name:THE FAMILY LIFE CENTER OF ROCKINGHAM CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-342-3160
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0941
Mailing Address - Country:US
Mailing Address - Phone:336-342-3160
Mailing Address - Fax:336-394-0039
Practice Address - Street 1:307 W MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-2521
Practice Address - Country:US
Practice Address - Phone:336-342-6130
Practice Address - Fax:336-394-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005823Medicaid