Provider Demographics
NPI:1700389053
Name:MATEO FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:MATEO FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIOCLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-896-2659
Mailing Address - Street 1:133 BOONES RIDGE PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:770-896-2659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty