Healthcare Provider Details

I. General information

NPI: 1558724047
Provider Name (Legal Business Name): FAMILY AND CHILDREN SUPPORT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7306 GA HIGHWAY 21 STE 101-270
PORT WENTWORTH GA
31407-9274
US

IV. Provider business mailing address

7306 GA HIGHWAY 21 STE 101-270
PORT WENTWORTH GA
31407-9274
US

V. Phone/Fax

Practice location:
  • Phone: 404-909-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RIPLEY JACKSON
Title or Position: CEO
Credential:
Phone: 404-909-2442