Provider Demographics
NPI:1992410716
Name:DEVANG FAMILY SERVICES
Entity type:Organization
Organization Name:DEVANG FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCMHC, NCC
Authorized Official - Phone:704-991-5159
Mailing Address - Street 1:2709 BLUE RIDGE RD
Mailing Address - Street 2:STE 190
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-322-0140
Mailing Address - Fax:
Practice Address - Street 1:2709 BLUE RIDGE RD STE 190
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-0113
Practice Address - Country:US
Practice Address - Phone:571-274-8132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty