| NPI | 1528643582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI HOLWAY Credentialing Specialist 601-382-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |