MEDICARE: THE FAMILY AND CHILDREN COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013140821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY AND CHILDREN COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	770-823-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	770-823-2277
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. RUSSELL K KAWAKAMI
Credential	:	PHD
Telephone Number	:	770-823-2277

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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