Provider Demographics
NPI:1497200570
Name:FAMILY CONNECTIONS COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:FAMILY CONNECTIONS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:LUSTER
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-434-2977
Mailing Address - Street 1:418 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4314
Mailing Address - Country:US
Mailing Address - Phone:601-434-2977
Mailing Address - Fax:
Practice Address - Street 1:418 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4314
Practice Address - Country:US
Practice Address - Phone:601-434-2977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC59191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1508192949OtherNPI
MS09907518Medicaid