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General NPI Number Information
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NPI Number | 1558724047
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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 | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 7306 GA HIGHWAY 21 STE 101-270
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-9274
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Country | US
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Telephone | 404-909-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 7306 GA HIGHWAY 21 STE 101-270
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-9274
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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 | RIPLEY JACKSON
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Credential |
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Telephone | 404-909-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 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 #4
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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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