| NPI | 1336641091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEISHA GREEN Owner 601-488-9668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MS R890966) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2021-08-04 |