Provider Demographics
NPI:1487948600
Name:FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-403-2692
Mailing Address - Street 1:301 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 202-B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2981
Mailing Address - Country:US
Mailing Address - Phone:704-403-2692
Mailing Address - Fax:
Practice Address - Street 1:301 MEDICAL PARK DR
Practice Address - Street 2:SUITE 202-B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2981
Practice Address - Country:US
Practice Address - Phone:704-403-2692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106674Medicaid