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General NPI Number Information
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NPI Number | 1649482795
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR FAMILY SYSTEMS SUPPORT
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 308 WEST COLLINS AVE
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City | LAKE PARK
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State | GA
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Zip | 31636
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Country | US
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Telephone | 229-559-8597
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Fax | 229-559-7760
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Provider Business Mailing Address
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Address Line | 308 WEST COLLINS AVE
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City | LAKE PARK
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State | GA
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Zip | 31636
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Country | US
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Telephone | 229-559-8597
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Fax | 229-559-7760
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. EDWARD E SANDERS JR.
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Credential | LMSW
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Telephone | 229-559-8597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW000179
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License Number State | GA
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