Healthcare Provider Details

I. General information

NPI: 1992065668
Provider Name (Legal Business Name): FAMILIES ADVOCACY FOR VOICES OF RESILIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 RAYS RD SUITE 9496
STONE MOUNTAIN GA
30083-3144
US

IV. Provider business mailing address

798 RAYS RD SUITE 9496
STONE MOUNTAIN GA
30083-3144
US

V. Phone/Fax

Practice location:
  • Phone: 404-499-0078
  • Fax:
Mailing address:
  • Phone: 404-499-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. CARMEN COATES
Title or Position: CEO/OWNER
Credential:
Phone: 404-587-8286