Provider Demographics
NPI:1700542420
Name:DEVELOP-MENTAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:DEVELOP-MENTAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-563-4788
Mailing Address - Street 1:587 N FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3900
Mailing Address - Country:US
Mailing Address - Phone:610-563-4788
Mailing Address - Fax:770-727-2065
Practice Address - Street 1:587 N FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3900
Practice Address - Country:US
Practice Address - Phone:610-563-4788
Practice Address - Fax:770-727-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health