Provider Demographics
NPI:1043631625
Name:DAUGHTERS OF THE KING MINISTRIES INC.
Entity Type:Organization
Organization Name:DAUGHTERS OF THE KING MINISTRIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:FULMORE
Authorized Official - Last Name:FAVORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-347-2480
Mailing Address - Street 1:323 HOSANNA CIR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8277
Mailing Address - Country:US
Mailing Address - Phone:229-347-2480
Mailing Address - Fax:
Practice Address - Street 1:311 S LEE ST
Practice Address - Street 2:APT C
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3971
Practice Address - Country:US
Practice Address - Phone:229-347-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13471797103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty