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General NPI Number Information
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NPI Number | 1518341445
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Entity Type | Organization
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Legal Business Name | COMPASSION FOSTERS CHANGE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 2855 CANDLER RD STE 9
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City | DECATUR
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State | GA
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Zip | 30034-1415
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Country | US
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Telephone | 404-272-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 ELKHORN DR
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City | DECATUR
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State | GA
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Zip | 30034-2721
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Country | US
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Telephone | 404-272-2896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DJUANA R. SWIFT
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Credential | LCSW
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Telephone | 404-272-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003918
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License Number State | GA
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