NPIMap

Organization Active NPI

Families Forward LLC

  • Clinical Child & Adolescent Psychologist
  • Martinez, GA
National Provider Identifier
1962750869
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PSY003096 Issued in GA
Legal business name
FAMILIES FORWARD LLC
Practice address
3711 Executive Center Dr
Suite 101
Martinez, GA 30907-0951
Phone
(706) 210-8855
Fax
(678) 541-7699
NPI assigned
Aug 27, 2012
Last updated
Nov 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dara A Delancy, PSY.D.NPI 1821289877
Title
Psychologist
Phone
(706) 210-8855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X PSY003096 GA Primary

Addresses

Primary practice location

3711 Executive Center Dr
Suite 101
Martinez, GA 30907-0951

Mailing address

3711 Executive Center Dr
Suite 101
Martinez, GA 30907-0951
Phone (706) 210-8855

National Provider Directory

National Provider Directory

Locations

3711 Executive Center Dr
Ste 101
Martinez, GA 30907
Phone (706) 210-8855

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1962750869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3711 EXECUTIVE CENTER DR",
            "address_2": "SUITE 101",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070951",
            "telephone_number": "706-210-8855",
            "fax_number": "678-541-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 EXECUTIVE CENTER DR",
            "address_2": "SUITE 101",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070951",
            "telephone_number": "706-210-8855",
            "fax_number": "678-541-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIES FORWARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "DELANCY",
        "authorized_official_first_name": "DARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "706-210-8855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY003096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.