| NPI | 1265254114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUARTIVIA RO'SCHELL GIBSON Administrator 601-910-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2024-10-30 |