Provider Demographics
NPI:1376755595
Name:4FUN, INC
Entity Type:Organization
Organization Name:4FUN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-764-6906
Mailing Address - Street 1:23439 GA HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31321-8515
Mailing Address - Country:US
Mailing Address - Phone:912-823-3183
Mailing Address - Fax:
Practice Address - Street 1:23439 GA HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-8515
Practice Address - Country:US
Practice Address - Phone:912-823-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003736251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health