Provider Demographics
NPI:1477646891
Name:FAMILY MAINTENANCE COUNSELING GROUP, INC.
Entity Type:Organization
Organization Name:FAMILY MAINTENANCE COUNSELING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QMHP
Authorized Official - Phone:804-440-8310
Mailing Address - Street 1:3900 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4202
Mailing Address - Country:US
Mailing Address - Phone:804-440-8310
Mailing Address - Fax:804-515-7703
Practice Address - Street 1:3900 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4202
Practice Address - Country:US
Practice Address - Phone:804-440-8310
Practice Address - Fax:804-515-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA79405001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010314542Medicaid