Provider Demographics
NPI:1528281425
Name:STRUCTURED FAMILY INTERVENTIONS, LLC
Entity type:Organization
Organization Name:STRUCTURED FAMILY INTERVENTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-416-0800
Mailing Address - Street 1:6011 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 104-C
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6248
Mailing Address - Country:US
Mailing Address - Phone:919-416-0800
Mailing Address - Fax:
Practice Address - Street 1:6011 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 104-C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6248
Practice Address - Country:US
Practice Address - Phone:919-416-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418578Medicaid
NC3418775Medicaid
NC8302972HMedicaid
NC8301584Medicaid
NC8302972VMedicaid
NC5950736Medicaid
NC6008042Medicaid
NC8302972GMedicaid
NC8302972Medicaid
NC8302972QMedicaid