Provider Demographics
NPI:1750619532
Name:FAMILY INTERVENTION & COMMUNITY ADVOCAY, LLC
Entity type:Organization
Organization Name:FAMILY INTERVENTION & COMMUNITY ADVOCAY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEMEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA,QMHP, QDDMHP
Authorized Official - Phone:704-719-6615
Mailing Address - Street 1:301 MCCULLOUGH DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:704-719-6615
Mailing Address - Fax:252-793-3117
Practice Address - Street 1:260 PEACHTREE ST NW
Practice Address - Street 2:SUITE 2200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1202
Practice Address - Country:US
Practice Address - Phone:704-719-6615
Practice Address - Fax:252-793-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care