| Dba | |
|
1004 Adams St Laurel MS 39440-4365 | |
| (601) 342-2461 | |
| (888) 449-9560 |
| Full Name | Dba |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1004 Adams St, Laurel, Mississippi |
| Authorized Official Name and Position | Latonya Hailes (ADMINSTRATOR) |
| Authorized Official Contact | 6013366114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba 1507 Hardy St Ste 201 Hattiesburg MS 39401-4978 Ph: (601) 336-6114 | Dba 1004 Adams St Laurel MS 39440-4365 Ph: (601) 342-2461 |
| NPI Number | 1952898322 |
|---|---|
| Provider Enumeration Date | 04/20/2018 |
| Last Update Date | 04/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952898322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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