| NPI | 1053885582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANAH EVANS Member 601-850-6189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |