Provider Demographics
NPI:1871634824
Name:UNDERDUE SOCIAL SERVICES
Entity Type:Organization
Organization Name:UNDERDUE SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-389-9886
Mailing Address - Street 1:1071 LAUREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8432
Mailing Address - Country:US
Mailing Address - Phone:678-851-9509
Mailing Address - Fax:
Practice Address - Street 1:165 BURKE ST
Practice Address - Street 2:SUITE 109
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3463
Practice Address - Country:US
Practice Address - Phone:770-389-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10048022OtherAMERIGROUP
GA205814758AOtherCENPATICO
GA205814758AMedicaid
GA833744000OtherMAGELLAN