Provider Demographics
NPI:1609210582
Name:INTERCONNECTED FAMILY AND CHILDREN SERVICES LLC
Entity Type:Organization
Organization Name:INTERCONNECTED FAMILY AND CHILDREN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-365-2375
Mailing Address - Street 1:1257 COMMERCIAL DR SW # SR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5991
Mailing Address - Country:US
Mailing Address - Phone:678-365-2375
Mailing Address - Fax:678-298-5098
Practice Address - Street 1:1257 COMMERCIAL DR SW # SR
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5991
Practice Address - Country:US
Practice Address - Phone:678-365-2375
Practice Address - Fax:678-298-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004040251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management