| NPI | 1750051173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRIC EDWARDS Medical Director 662-934-8671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2021-09-16 |