Provider Demographics
NPI:1487789137
Name:FAMILY VIOLENCE PROGRAM, INC. OF PITT COUNTY
Entity type:Organization
Organization Name:FAMILY VIOLENCE PROGRAM, INC. OF PITT COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-4400
Mailing Address - Street 1:PO BOX 8429
Mailing Address - Street 2:823 S. EVANS STREET
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8429
Mailing Address - Country:US
Mailing Address - Phone:252-758-4400
Mailing Address - Fax:252-752-4197
Practice Address - Street 1:823 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3267
Practice Address - Country:US
Practice Address - Phone:252-758-4400
Practice Address - Fax:252-752-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89714101YA0400X, 101YM0800X, 1041C0700X, 106H00000X, 163WP0807X, 163WP0809X, 171M00000X, 171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Not Answered171R00000XOther Service ProvidersInterpreterGroup - Single Specialty