=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710315239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MATTERS COUNSELING CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2013
-----------------------------------------------------
Last Update Date | 10/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 EASTBROOK BND SUITE 218
-----------------------------------------------------
City | PEACHTREE CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-487-8017
-----------------------------------------------------
Fax | 404-973-0184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2427 CENTENNIAL HILL WAY NW
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-2184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-487-8017
-----------------------------------------------------
Fax | 404-973-0184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAULA ABRAMS
-----------------------------------------------------
Credential | ED.S., LMFT, LPC
-----------------------------------------------------
Telephone | 770-487-8017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 770
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------