MEDICARE: FAMILY FUNCTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	N/A	GA
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	N/A	GA

General Provider Information

NPI Number	:	1528384492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FUNCTIONS, LLC

Provider Business Mailing Address
First Line	:	3113 ABBEY DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5477
Country	:	US
Telephone Number	:	404-629-6005
Fax Number	:	866-830-7191

Provider Business Practice Location Address
First Line	:	3113 ABBEY DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5477
Country	:	US
Telephone Number	:	404-629-6005
Fax Number	:	866-830-7191

Authorized Official
Title or Position	:	CEO
Name	:	MS. ETERICA DIONNE RUCKS
Credential	:	LCSW
Telephone Number	:	404-423-5900

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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Directions to “FAMILY FUNCTIONS, LLC ” Practice Location

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