Provider Demographics
NPI:1770124943
Name:IKESTINES FAMILY SOLUTION
Entity type:Organization
Organization Name:IKESTINES FAMILY SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISIAHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-457-6005
Mailing Address - Street 1:22 CALICO LN
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-7202
Mailing Address - Country:US
Mailing Address - Phone:478-457-6005
Mailing Address - Fax:
Practice Address - Street 1:22 CALICO LN
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-7202
Practice Address - Country:US
Practice Address - Phone:478-457-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty