| NPI | 1194421859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALONZO LAWRENCE Owner 601-791-4368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-03-28 |