MEDICARE: FAMILY AND CHILDREN SUPPORT, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC1900X	Counseling Psychologist
3	1041C0700X	Clinical Social Worker
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1558724047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AND CHILDREN SUPPORT, INC

Provider Business Mailing Address
First Line	:	7306 GA HIGHWAY 21
Second Line	:	STE 101-270
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9274
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7306 GA HIGHWAY 21
Second Line	:	STE 101-270
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9274
Country	:	US
Telephone Number	:	404-909-2442
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RIPLEY JACKSON
Credential	:
Telephone Number	:	404-909-2442

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	04/01/2016

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