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General NPI Number Information
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NPI Number | 1336458199
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 2385 WALL ST SE
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City | CONYERS
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State | GA
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Zip | 30013-2187
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Country | US
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Telephone | 678-849-0324
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Fax | 770-388-0955
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Provider Business Mailing Address
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Address Line | 2385 WALL ST SE
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City | CONYERS
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State | GA
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Zip | 30013-2187
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Country | US
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Telephone | 678-849-0324
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Fax | 770-388-0955
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | DR. MARIA LUCIE BEJACMAR-DIDIER
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Credential | PH.D., LCSW, CCDP-D
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Telephone | 678-849-0324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003742
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License Number State | GA
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