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 |