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Organization
FAMILIAL BONDS LLC
Active
Organization
FAMILIAL BONDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAQUANDA JEFFERSON MAMFT (PSYCHOTHERAPIST)
(678) 468-0442
Entity
Organization
Contact information
Practice address
870 CRESTMARK DR STE 103, LITHIA SPRINGS, GA 30122-2665
(770) 672-0376
(770) 672-0376
Mailing address
PO BOX 5191, DOUGLASVILLE, GA 30154-0004
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
07/31/2017
Last updated
01/21/2021
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