Provider Demographics
NPI:1841460987
Name:JOHARI FAMILY SERVICES
Entity type:Organization
Organization Name:JOHARI FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:JOHARI
Authorized Official - Last Name:INNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-3000
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0878
Mailing Address - Country:US
Mailing Address - Phone:910-897-3000
Mailing Address - Fax:910-897-3004
Practice Address - Street 1:27 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521-0878
Practice Address - Country:US
Practice Address - Phone:910-897-3000
Practice Address - Fax:910-897-3004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHARI FAMILY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NCMHL043071251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063661965OtherNPI
NC1609051275OtherNPI