Provider Demographics
NPI:1982703708
Name:FAMMAT (FAMILY MATTERS) SERVICES LLC
Entity Type:Organization
Organization Name:FAMMAT (FAMILY MATTERS) SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GHOLSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:757-223-9177
Mailing Address - Street 1:813 FORREST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4513
Mailing Address - Country:US
Mailing Address - Phone:757-223-9177
Mailing Address - Fax:757-240-4091
Practice Address - Street 1:813 FORREST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4513
Practice Address - Country:US
Practice Address - Phone:757-223-9177
Practice Address - Fax:757-240-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA666-03-001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services