| NPI | 1891437653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARIA SHAUNTE WADE Mental Health Provider 601-596-5489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-04-12 |