Provider Demographics
NPI:1336458199
Name:MENTAL HEALTH FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUCIE
Authorized Official - Last Name:BEJACMAR-DIDIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, CCDP-D
Authorized Official - Phone:678-849-0324
Mailing Address - Street 1:2385 WALL ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2187
Mailing Address - Country:US
Mailing Address - Phone:678-849-0324
Mailing Address - Fax:770-388-0955
Practice Address - Street 1:2385 WALL ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2187
Practice Address - Country:US
Practice Address - Phone:678-849-0324
Practice Address - Fax:770-388-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty