Provider Demographics
NPI:1235298621
Name:FAMILY IMPACT INC
Entity type:Organization
Organization Name:FAMILY IMPACT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:MATTOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-276-1777
Mailing Address - Street 1:300 A TURNER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-276-1777
Mailing Address - Fax:804-276-1877
Practice Address - Street 1:304 B TURNER RD
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-276-1777
Practice Address - Fax:804-276-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA784101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty