Provider Demographics
NPI:1114330776
Name:FACES, LLC
Entity Type:Organization
Organization Name:FACES, LLC
Other - Org Name:FACES THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-861-0253
Mailing Address - Street 1:318 SAINT PAULS CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1092
Mailing Address - Country:US
Mailing Address - Phone:770-861-0253
Mailing Address - Fax:404-494-7701
Practice Address - Street 1:1 W COURT SQ STE 750
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2545
Practice Address - Country:US
Practice Address - Phone:770-861-0253
Practice Address - Fax:404-494-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1041C0700XOtherCLINICAL SOCIAL WORKER