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General NPI Number Information
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NPI Number | 1770124943
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Entity Type | Organization
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Legal Business Name | IKESTINES FAMILY SOLUTION
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 22 CALICO LN
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City | FORT VALLEY
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State | GA
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Zip | 31030-7202
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Country | US
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Telephone | 478-457-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CALICO LN
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City | FORT VALLEY
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State | GA
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Zip | 31030-7202
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Country | US
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Telephone | 478-457-6005
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. ISIAHIA GUYTON
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Credential |
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Telephone | 478-457-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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