| NPI | 1659311967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ALLEN GONSALVES President Of Corporation Private 601-551-1327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C5647) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-10-19 |