Provider Demographics
NPI:1629544341
Name:RESILIENT FOCUSED FAMILY THERAPY
Entity Type:Organization
Organization Name:RESILIENT FOCUSED FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SYKES-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:404-421-2896
Mailing Address - Street 1:6179 CHASTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2479
Mailing Address - Country:US
Mailing Address - Phone:404-421-2896
Mailing Address - Fax:
Practice Address - Street 1:6179 CHASTAIN WAY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2479
Practice Address - Country:US
Practice Address - Phone:404-421-2896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty