Provider Demographics
NPI:1003001801
Name:FAMILY CARE AND COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY CARE AND COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OBADIAH
Authorized Official - Middle Name:TENTISHE
Authorized Official - Last Name:YUSUFU
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:770-366-3163
Mailing Address - Street 1:1105 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2947
Mailing Address - Country:US
Mailing Address - Phone:770-366-3163
Mailing Address - Fax:770-837-3511
Practice Address - Street 1:1105 PALMER RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2947
Practice Address - Country:US
Practice Address - Phone:770-366-3163
Practice Address - Fax:770-837-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251SOOOOOX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA75934753AMedicaid