Organization
FONSECA FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GERNISHA A FONSECA (CEO)
(919) 683-1500
Entity
Organization
Contact information
Practice address
1111 FAYETTEVILLE ST, DURHAM, NC 27701-3918
(919) 683-1500
(919) 683-1004
Mailing address
1111 FAYETTEVILLE ST, DURHAM, NC 27701-3918
(919) 683-1500
(919) 683-1004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301961
—
NC
Enumeration date
01/10/2008
Last updated
01/10/2008
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