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General NPI Number Information
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NPI Number | 1124488283
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Entity Type | Organization
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Legal Business Name | FAMILY SUPPORT GROUP INC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 139 BOULDER VIEW PKWY
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City | DALLAS
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State | GA
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Zip | 30157-2311
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Country | US
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Telephone | 919-539-4212
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Fax | 678-609-5608
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Provider Business Mailing Address
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Address Line | 5917 WESSEL WAY
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City | RALEIGH
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State | NC
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Zip | 27610-4260
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Country | US
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Telephone | 919-539-4212
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Fax | 678-609-5608
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Authorized Official
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Title or Position | DIRECTOR
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Name | TONYA SIMMONS
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Credential |
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Telephone | 919-539-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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