Provider Demographics
NPI:1932553690
Name:FOUNDATION FAMILY CARE P.C.
Entity Type:Organization
Organization Name:FOUNDATION FAMILY CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-575-9289
Mailing Address - Street 1:1020 CREWS RD STE M
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7587
Mailing Address - Country:US
Mailing Address - Phone:704-575-9289
Mailing Address - Fax:877-548-5345
Practice Address - Street 1:1020 CREWS RD STE M
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7587
Practice Address - Country:US
Practice Address - Phone:704-575-9289
Practice Address - Fax:877-548-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000815Medicaid