Healthcare Provider Details

I. General information

NPI: 1508337924
Provider Name (Legal Business Name): FAMILY SOLUTIONS OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 PARKLAKE DR NE STE 533
ATLANTA GA
30345-2896
US

IV. Provider business mailing address

6949 MAHONIA PL
LITHONIA GA
30038-4588
US

V. Phone/Fax

Practice location:
  • Phone: 678-794-5314
  • Fax:
Mailing address:
  • Phone: 404-917-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLARINDA SQUIRES
Title or Position: OWNER
Credential: LCSW
Phone: 404-917-9430