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General NPI Number Information
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NPI Number | 1912064197
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Entity Type | Organization
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Legal Business Name | FAMILY'S MATTER
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3951 SNAPFINGER PKWY
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City | DECATUR
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State | GA
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Zip | 30035-3204
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Country | US
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Telephone | 404-578-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 SNAPFINGER PKWY
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City | DECATUR
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State | GA
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Zip | 30035-3204
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Country | US
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Telephone | 404-578-1577
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. VICTOR T GRIMES
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Credential | LPC
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Telephone | 404-578-1577
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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 | 004452
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License Number State | GA
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