| Central Mississippi Prevention Services Inc | |
|
1911 Mission 66 Ste B Vicksburg MS 39180-3762 | |
| (601) 631-0102 | |
| (601) 631-0131 |
| Full Name | Central Mississippi Prevention Services Inc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1911 Mission 66 Ste B, Vicksburg, Mississippi |
| Authorized Official Name and Position | Joseph Daniel Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6016310102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Mississippi Prevention Services Inc 1911 Mission 66 Ste B Vicksburg MS 39180-3762 Ph: (601) 631-0102 | Central Mississippi Prevention Services Inc 1911 Mission 66 Ste B Vicksburg MS 39180-3762 Ph: (601) 631-0102 |
| NPI Number | 1942478144 |
|---|---|
| Provider Enumeration Date | 02/11/2008 |
| Last Update Date | 02/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942478144 | NPI | - | NPPES |
| 00535256 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C1126 (Mississippi) | Primary |
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