Provider Demographics
NPI:1750431318
Name:FAMILY INTERVENTION & PREVENTION SERVICES, LLC
Entity type:Organization
Organization Name:FAMILY INTERVENTION & PREVENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:919-340-1626
Mailing Address - Street 1:211 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2526
Mailing Address - Country:US
Mailing Address - Phone:919-340-1626
Mailing Address - Fax:919-340-1627
Practice Address - Street 1:200 PARKVIEW DRIVE WEST
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2526
Practice Address - Country:US
Practice Address - Phone:252-572-2342
Practice Address - Fax:252-572-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X, 1835P1300X, 251B00000X, 251S00000X
NCMHL-035-052251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty
No251B00000XAgenciesCase Management