| NPI | 1003757675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK DEWAYNER DAVIS 3 C 601-718-2468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2026-04-06 |
| Last Update Date | 2026-04-06 |