Healthcare Provider Details

I. General information

NPI: 1356716328
Provider Name (Legal Business Name): FAMILY AND CHILDREN SUPPORT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 GA HIGHWAY 21 S UNIT 6
RINCON GA
31326-5505
US

IV. Provider business mailing address

1639 BRADLEY PARK DR 500
COLUMBUS GA
31904-3620
US

V. Phone/Fax

Practice location:
  • Phone: 912-988-3649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNEITH DURDEN
Title or Position: CEO
Credential:
Phone: 478-455-2092