Provider Demographics
NPI:1720482052
Name:FAMILY AND COMMUNITY OUTREACH MINISTRIES, INC.
Entity Type:Organization
Organization Name:FAMILY AND COMMUNITY OUTREACH MINISTRIES, INC.
Other - Org Name:GRACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCCC
Authorized Official - Phone:706-327-5055
Mailing Address - Street 1:5964 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4662
Mailing Address - Country:US
Mailing Address - Phone:706-327-5055
Mailing Address - Fax:
Practice Address - Street 1:5964 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4662
Practice Address - Country:US
Practice Address - Phone:706-327-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY AND COMMUNITY OUTREACH MINISTRIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06143496101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty