Organization
UNDERDUE SOCIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KIMBERLY UNDERDUE LCSW (CEO)
(770) 389-9886
Entity
Organization
Contact information
Practice address
165 BURKE ST, SUITE 109, STOCKBRIDGE, GA 30281-3463
(770) 389-9886
Mailing address
1071 LAUREL RIDGE DR, MCDONOUGH, GA 30252-8432
(678) 851-9509
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10048022
AMERIGROUP
GA
01
—
205814758A
CENPATICO
GA
05
—
205814758A
—
GA
01
—
833744000
MAGELLAN
GA
Enumeration date
02/12/2007
Last updated
12/14/2010
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