| NPI | 1306178694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE VAN Executive Director 601-824-0342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MS R08-BMR-WAC-PREVOC-0) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2022-06-27 |