Provider Demographics
NPI:1306073150
Name:FAMILY OUTREACH & COUNSELING ,INC
Entity type:Organization
Organization Name:FAMILY OUTREACH & COUNSELING ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT,CSMS,CFAE
Authorized Official - Phone:704-333-2033
Mailing Address - Street 1:700 PARKWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2655
Mailing Address - Country:US
Mailing Address - Phone:704-333-2033
Mailing Address - Fax:704-333-3639
Practice Address - Street 1:700 PARKWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2655
Practice Address - Country:US
Practice Address - Phone:704-333-2033
Practice Address - Fax:704-333-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC306101YP2500X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty