| NPI | 1437784550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTAL SULLIVAN Nurse Practitioner 228-331-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2020-03-11 |