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ASSOCIATED FAMILY AND LIFE SERVICES, LLC
Complete NPI Record 1487805321
Counselor in Durham, NC

NPI Status: Active since October 09, 2008

Contact Information

2144 PAGE RD
SUITE 204
DURHAM, NC
ZIP 27703
Phone: (919) 797-2507
Fax: (919) 908-8207

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Healthcare Provider Primary Taxonomy Switch 3
  33. Healthcare Provider Taxonomy Code 4
  34. Healthcare Provider Primary Taxonomy Switch 4
  35. Healthcare Provider Taxonomy Code 5
  36. Healthcare Provider Primary Taxonomy Switch 5
  37. Healthcare Provider Taxonomy Code 6
  38. Healthcare Provider Primary Taxonomy Switch 6
  39. Is Organization Subpart
  40. Authorized Official Name Prefix Text
  41. Authorized Official Credential Text
  42. Healthcare Provider Taxonomy Group 3
  43. Healthcare Provider Taxonomy Group 4
  44. Healthcare Provider Taxonomy Group 5
  45. Healthcare Provider Taxonomy Group 6

Complete NPI Dataset

This page represents the complete record for NPI 1487805321. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1487805321
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 2144 PAGE RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 204
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: DURHAM
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NC
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 277035952
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 9197972507
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 9199088207
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2144 PAGE RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 204
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: DURHAM
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address State Name: NC
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Postal Code: 277035952
The date that a record was last updated or changed.
Provider Business Practice Location Address Country Code If outside U S : US
The code designating the provider’s gender if the provider is a person.
Provider Business Practice Location Address Telephone Number: 9197972507
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Business Practice Location Address Fax Number: 9199088207
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Enumeration Date: 10/9/2008
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Last Update Date: 5/12/2014
Authorized Official Last Name: VICKERS
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Authorized Official First Name: WINSTON
The first name of the authorized official.
Authorized Official Title or Position: DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 9197249157
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 305R00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 251S00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 101YM0800X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 101YA0400X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 101YP2500X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 101Y00000X
Healthcare Provider Primary Taxonomy Switch 6: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Authorized Official Credential Text: BSBA
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP