| NPI | 1548501448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROLYN FAITH BANKS Administrator 601-250-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C3010) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 7505) |
| Enumeration Date | 2013-03-03 |
| Last Update Date | 2013-03-11 |