Healthcare Provider Details

I. General information

NPI: 1164689238
Provider Name (Legal Business Name): FAMILY AND YOUTH INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BUFORD HIGHWAY SUITE R4
SUGAR HILL GA
30518-8777
US

IV. Provider business mailing address

1400 BUFORD HIGHWAY SUITE R4
SUGAR HILL GA
30518-8777
US

V. Phone/Fax

Practice location:
  • Phone: 678-804-8823
  • Fax: 678-804-8827
Mailing address:
  • Phone: 678-804-8823
  • Fax: 678-804-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MARGIE GILL
Title or Position: MANAGING MEMBER
Credential:
Phone: 678-804-8823