NPI | 1043097421 |
---|---|
Entity Type | Organization |
Authorized Contact | TRACI LYNN GIBBS Owner 601-692-8997 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
Enumeration Date | 2023-09-11 |
Last Update Date | 2023-09-11 |