| NPI | 1184662694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTAVIA DORSEY Credentialing Mgr 601-249-4235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-04-06 |