| NPI | 1609249366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNETTA LESIA BOLDEN Counselor 601-624-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 1825) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2015-11-03 |