Provider Demographics
NPI:1225461809
Name:FATHERS' UPLIFT
Entity Type:Organization
Organization Name:FATHERS' UPLIFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:404-512-6891
Mailing Address - Street 1:145 WILLARD ST APT A3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1533
Mailing Address - Country:US
Mailing Address - Phone:404-512-6891
Mailing Address - Fax:
Practice Address - Street 1:145 WILLARD ST APT A3
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1533
Practice Address - Country:US
Practice Address - Phone:404-512-6891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health