# FAMILY 360 INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003113184
- **Authorized official:** DR. DESMOND ORVILLE MAUL (OWNER)
- **Authorized official phone:** (770) 679-0586

## Contact information

- **Practice address:** 2215 EXCHANGE PL SE STE A, CONYERS, GA 30013-6723
- **Practice address phone:** (770) 679-0586
- **Practice address fax:** (770) 554-9349
- **Mailing address:** 2215 EXCHANGE PL SE STE A, CONYERS, GA 30013-6723
- **Mailing address phone:** (770) 679-0586
- **Mailing address fax:** (770) 285-6325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | MFT 001191 | GA | Yes |

## Other

- **Enumeration date:** 02/25/2011
- **Last updated:** 02/07/2024