# THE MARGIE REE HANSFORD THURMOND FAMILY LIFE CENTER

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

## Provider details

- **NPI number:** 1376019141
- **Authorized official:** DR. MYRNA THURMOND MALONE CPC (CLINICAL DIRECTOR)
- **Authorized official phone:** (770) 468-7100

## Contact information

- **Practice address:** 710 KING RD, RIVERDALE, GA 30274-2027
- **Practice address phone:** (770) 468-7100
- **Mailing address:** 9100 AMBERLEIGH LN, RIVERDALE, GA 30274-4682
- **Mailing address phone:** (770) 468-7100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YP1600X | Pastoral Counselor | — | NULL | Yes |
| 101YP1600X | Pastoral Counselor | — | — | Yes |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 10/19/2018
- **Last updated:** 10/19/2018