Provider Demographics
NPI:1164689238
Name:FAMILY AND YOUTH INTERVENTIONS, LLC
Entity Type:Organization
Organization Name:FAMILY AND YOUTH INTERVENTIONS, LLC
Other - Org Name:FYI, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-804-8823
Mailing Address - Street 1:1400 BUFORD HIGHWAY
Mailing Address - Street 2:SUITE R4
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8777
Mailing Address - Country:US
Mailing Address - Phone:678-804-8823
Mailing Address - Fax:678-804-8827
Practice Address - Street 1:1400 BUFORD HIGHWAY
Practice Address - Street 2:SUITE R4
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8777
Practice Address - Country:US
Practice Address - Phone:678-804-8823
Practice Address - Fax:678-804-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0801X
GA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health