Provider Demographics
NPI:1124771548
Name:COMMUNITY FAMILY THERAPY
Entity type:Organization
Organization Name:COMMUNITY FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-501-4656
Mailing Address - Street 1:8004 LINVILLE RD # 14
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8004 LINVILLE RD STE C2
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9812
Practice Address - Country:US
Practice Address - Phone:703-888-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083366496OtherSOCIAL WORKER/CLINICAL
NC1366815755OtherSOCIAL WORKER/CLINICAL