| NPI | 1740650969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLIE G NDIAYE Registered Nurse 662-803-1254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 0050750) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MS 08533763) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |