| NPI | 1730661331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY W FERGUSON CEO 662-760-0052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2021-11-07 |