Provider Demographics
NPI:1528384492
Name:FAMILY FUNCTIONS, LLC
Entity Type:Organization
Organization Name:FAMILY FUNCTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ETERICA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:RUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-423-5900
Mailing Address - Street 1:3113 ABBEY DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5477
Mailing Address - Country:US
Mailing Address - Phone:404-629-6005
Mailing Address - Fax:866-830-7191
Practice Address - Street 1:3113 ABBEY DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5477
Practice Address - Country:US
Practice Address - Phone:404-629-6005
Practice Address - Fax:866-830-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAN/A261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health