Provider Demographics
NPI:1336458991
Name:FAMILY SUPPORT CIRCLE, INC.
Entity Type:Organization
Organization Name:FAMILY SUPPORT CIRCLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:770-378-4070
Mailing Address - Street 1:1479 TETHER LN
Mailing Address - Street 2:P.O.BOX 2439
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9209
Mailing Address - Country:US
Mailing Address - Phone:770-378-4070
Mailing Address - Fax:
Practice Address - Street 1:1479 TETHER LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9209
Practice Address - Country:US
Practice Address - Phone:770-378-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X, 103TB0200X, 3245S0500X, 385HR2055X, 385HR2060X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child