Provider Demographics
NPI:1588772032
Name:FAMILY INTERVENTION SPECIALIST'S, INC
Entity type:Organization
Organization Name:FAMILY INTERVENTION SPECIALIST'S, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-663-8877
Mailing Address - Street 1:126 ENTERPRISE PATH
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2656
Mailing Address - Country:US
Mailing Address - Phone:770-222-6622
Mailing Address - Fax:770-234-4202
Practice Address - Street 1:126 ENTERPRISE PATH
Practice Address - Street 2:SUITE 101
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2656
Practice Address - Country:US
Practice Address - Phone:770-222-6622
Practice Address - Fax:770-234-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001837101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty