| NPI | 1730663469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA KILLEBREW Owner 601-750-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2018-09-19 |