Provider Demographics
NPI:1376019141
Name:THE MARGIE REE HANSFORD THURMOND FAMILY LIFE CENTER
Entity Type:Organization
Organization Name:THE MARGIE REE HANSFORD THURMOND FAMILY LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMOND MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:770-468-7100
Mailing Address - Street 1:9100 AMBERLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4682
Mailing Address - Country:US
Mailing Address - Phone:770-468-7100
Mailing Address - Fax:
Practice Address - Street 1:710 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2027
Practice Address - Country:US
Practice Address - Phone:770-468-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty