Healthcare Provider Details

I. General information

NPI: 1235219841
Provider Name (Legal Business Name): FAMILY STABILIZATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MILLER RD
SUMTER SC
29150-3366
US

IV. Provider business mailing address

PO BOX 7357
SUMTER SC
29150
US

V. Phone/Fax

Practice location:
  • Phone: 803-467-1263
  • Fax: 803-234-6434
Mailing address:
  • Phone: 803-467-1263
  • Fax: 803-234-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1040
License Number StateSC

VIII. Authorized Official

Name: MR. GEROD GORE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSSA, LBSW
Phone: 803-467-1263