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General NPI Number Information
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NPI Number | 1528384492
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Entity Type | Organization
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Legal Business Name | FAMILY FUNCTIONS, LLC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 3113 ABBEY DR SW
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City | ATLANTA
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State | GA
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Zip | 30331-5477
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Country | US
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Telephone | 404-629-6005
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Fax | 866-830-7191
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Provider Business Mailing Address
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Address Line | 3113 ABBEY DR SW
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City | ATLANTA
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State | GA
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Zip | 30331-5477
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Country | US
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Telephone | 404-629-6005
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Fax | 866-830-7191
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Authorized Official
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Title or Position | CEO
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Name | MS. ETERICA DIONNE RUCKS
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Credential | LCSW
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Telephone | 404-423-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | N/A
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | N/A
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License Number State | GA
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