| NPI | 1700122074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BLALOCK HENRY Owner/Director 601-310-1057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: KS 1099) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2012-12-14 |