Provider Demographics
| NPI: | 1780871293 |
|---|---|
| Name: | FAMILY FIRST COMMUNITY SERVICES, LLC |
| Entity type: | Organization |
| Organization Name: | FAMILY FIRST COMMUNITY SERVICES, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | MICHIKO |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | DOWDY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | BSW |
| Authorized Official - Phone: | 704-364-3989 |
| Mailing Address - Street 1: | 3705 LATROBE DR |
| Mailing Address - Street 2: | SUITE 340 |
| Mailing Address - City: | CHARLOTTE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28211-4824 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 704-364-3989 |
| Mailing Address - Fax: | 704-364-3974 |
| Practice Address - Street 1: | 3705 LATROBE DR |
| Practice Address - Street 2: | SUITE 340 |
| Practice Address - City: | CHARLOTTE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28211-4824 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 704-364-3989 |
| Practice Address - Fax: | 704-364-3974 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-09-28 |
| Last Update Date: | 2023-02-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 6006232 | Medicaid |
