| NPI | 1821536392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN K DAVIDSON Clinical Therapist 601-818-0167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MS T0440) |
| Additional Taxonomies | 251B00000X Case Management (Licence: MS T0440) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2018-06-20 |