| Desoto Wellness Clinic Llc | |
|
8829 Centre St Ste 100 Southaven MS 38671-2610 | |
| (662) 934-8671 | |
| Not Available |
| Full Name | Desoto Wellness Clinic Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 8829 Centre St Ste 100, Southaven, Mississippi |
| Authorized Official Name and Position | Cedric Edwards (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6629348671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Wellness Clinic Llc 222 Southlakes Dr Grenada MS 38901-8499 Ph: (662) 934-8671 | Desoto Wellness Clinic Llc 8829 Centre St Ste 100 Southaven MS 38671-2610 Ph: (662) 934-8671 |
| NPI Number | 1750051173 |
|---|---|
| Provider Enumeration Date | 09/16/2021 |
| Last Update Date | 09/16/2021 |
| Certification Date | 09/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750051173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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