| Ignite Clinical Wellness Group | |
|
5600 Goodman Rd Ste G Olive Branch MS 38654-7002 | |
| (662) 985-4101 | |
| (662) 404-7288 |
| Full Name | Ignite Clinical Wellness Group |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5600 Goodman Rd Ste G, Olive Branch, Mississippi |
| Authorized Official Name and Position | Derrick O Roach (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 9018592071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ignite Clinical Wellness Group 5600 Goodman Rd Ste G Olive Branch MS 38654-7002 Ph: (662) 985-4101 | Ignite Clinical Wellness Group 5600 Goodman Rd Ste G Olive Branch MS 38654-7002 Ph: (662) 985-4101 |
| NPI Number | 1184305666 |
|---|---|
| Provider Enumeration Date | 07/27/2023 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184305666 | NPI | - | NPPES |
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