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General NPI Number Information
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NPI Number | 1740540533
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Entity Type | Organization
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Legal Business Name | MAC FAMILY CENTER
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 2336 WISTERIA DR 230
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City | SNELLVILLE
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State | GA
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Zip | 30078-6191
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Country | US
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Telephone | 770-979-6000
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Fax | 877-872-1932
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Provider Business Mailing Address
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Address Line | PO BOX 734
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City | GRAYSON
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State | GA
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Zip | 30017-0013
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Country | US
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Telephone | 404-955-0875
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Fax | 877-872-1932
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | STACEE R BROWN
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Credential |
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Telephone | 770-979-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 006296
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License Number State | GA
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