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General NPI Number Information
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NPI Number | 1356716328
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Entity Type | Organization
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Legal Business Name | FAMILY AND CHILDREN SUPPORT, INC
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 5910 GA HIGHWAY 21 S UNIT 6
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City | RINCON
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State | GA
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Zip | 31326-5505
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Country | US
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Telephone | 912-988-3649
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Fax |
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Provider Business Mailing Address
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Address Line | 1639 BRADLEY PARK DR 500
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City | COLUMBUS
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State | GA
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Zip | 31904-3620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KENNEITH DURDEN
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Credential |
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Telephone | 478-455-2092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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