Southeast Family Services of Raleigh

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

3757 Issued in NC

Legal business name

SOUTHEAST FAMILY SERVICES OF RALEIGH

Practice address

3716 National Dr
Suite 124
Raleigh, NC 27612-4068

Phone

(919) 783-8846

Fax

(919) 783-7305

NPI assigned

May 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brenda Vath

Title

Office Manager

Phone

(919) 783-8846

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1902199748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 NATIONAL DR",
            "address_2": "SUITE 124",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124068",
            "telephone_number": "919-783-8846",
            "fax_number": "919-783-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 NATIONAL DR",
            "address_2": "SUITE 124",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124068",
            "telephone_number": "919-783-8846",
            "fax_number": "919-783-7305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST FAMILY SERVICES OF RALEIGH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "VATH",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "919-783-8846"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "3757",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NC",
            "license": "5028",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "6834",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Eastern Medical Suplies,Inc
• Southeast Family Services, LLC
• Southeast Primary Care, PLLC
• Southeastern Adult Day Center
• Southeastern Adult Day Center
• Southeastern Adult Day Center

• Clinical Child & Adolescent Psychologist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.