Provider Demographics
NPI:1740540533
Name:MAC FAMILY CENTER
Entity type:Organization
Organization Name:MAC FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-979-6000
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-0013
Mailing Address - Country:US
Mailing Address - Phone:404-955-0875
Mailing Address - Fax:877-872-1932
Practice Address - Street 1:2336 WISTERIA DR
Practice Address - Street 2:230
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6191
Practice Address - Country:US
Practice Address - Phone:770-979-6000
Practice Address - Fax:877-872-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty