Provider Demographics
NPI:1962784397
Name:FOUNDATION FOR FAMILIES, LLC
Entity type:Organization
Organization Name:FOUNDATION FOR FAMILIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-521-0077
Mailing Address - Street 1:PO BOX 4108
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-4108
Mailing Address - Country:US
Mailing Address - Phone:910-521-0077
Mailing Address - Fax:910-521-4877
Practice Address - Street 1:30 THREE HUNTS DR
Practice Address - Street 2:SUITE B
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7316
Practice Address - Country:US
Practice Address - Phone:910-521-0077
Practice Address - Fax:910-521-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO6439251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health