| NPI | 1184057556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY S GREEN Billing Manager 601-835-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C5077) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2013-11-08 |