Provider Demographics
NPI:1962750869
Name:FAMILIES FORWARD LLC
Entity type:Organization
Organization Name:FAMILIES FORWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELANCY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-210-8855
Mailing Address - Street 1:3711 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0951
Mailing Address - Country:US
Mailing Address - Phone:706-210-8855
Mailing Address - Fax:678-541-7699
Practice Address - Street 1:3711 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0951
Practice Address - Country:US
Practice Address - Phone:706-210-8855
Practice Address - Fax:678-541-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003096103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA447024026CMedicaid