Provider Demographics
NPI:1295194371
Name:FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-840-3267
Mailing Address - Street 1:610 E DIAMOND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-5321
Mailing Address - Country:US
Mailing Address - Phone:301-840-2000
Mailing Address - Fax:301-840-9621
Practice Address - Street 1:630 EAST DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5321
Practice Address - Country:US
Practice Address - Phone:301-840-3292
Practice Address - Fax:301-963-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MD588881600261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1780641928Medicaid
MD1518157965Medicaid
MD1194115170Medicaid
MD1437273372Medicaid