| NPI | 1093366775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN KIM WAGGONER CEO 228-819-2171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist Clinical | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2024-06-10 |