Provider Demographics
NPI:1316106495
Name:DETACHED FATHERS AND MOTHERS
Entity type:Organization
Organization Name:DETACHED FATHERS AND MOTHERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-930-3994
Mailing Address - Street 1:8107 UNIVERSITY RIDGE DR
Mailing Address - Street 2:UNIT 108
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4114
Mailing Address - Country:US
Mailing Address - Phone:704-930-3994
Mailing Address - Fax:
Practice Address - Street 1:312 W TRADE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1557
Practice Address - Country:US
Practice Address - Phone:704-930-3994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health