Provider Demographics
NPI:1881479459
Name:FAMILY ADVOCATE LLC
Entity type:Organization
Organization Name:FAMILY ADVOCATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA, LCASA
Authorized Official - Phone:304-887-7202
Mailing Address - Street 1:4129 DEERFIELD DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4519
Mailing Address - Country:US
Mailing Address - Phone:304-887-7202
Mailing Address - Fax:
Practice Address - Street 1:4129 DEERFIELD DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4519
Practice Address - Country:US
Practice Address - Phone:304-887-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health