Provider Demographics
NPI:1528393592
Name:FAMILYS MATTER COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:FAMILYS MATTER COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-602-0182
Mailing Address - Street 1:4568 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:SUITE 201 C
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3618
Mailing Address - Country:US
Mailing Address - Phone:404-602-0182
Mailing Address - Fax:404-602-0069
Practice Address - Street 1:4568 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 201 C
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3618
Practice Address - Country:US
Practice Address - Phone:404-602-0182
Practice Address - Fax:404-602-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004452251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health