Provider Demographics
NPI:1407112360
Name:TODAY'S FAMILY TIES
Entity Type:Organization
Organization Name:TODAY'S FAMILY TIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY RESOURCE SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:404-433-0307
Mailing Address - Street 1:6439 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2904
Mailing Address - Country:US
Mailing Address - Phone:404-433-0307
Mailing Address - Fax:
Practice Address - Street 1:6439 BRIARWOOD CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2904
Practice Address - Country:US
Practice Address - Phone:404-433-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12-00036428251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency