| Imani Community Center | |
|
207 Poplar St Kosciusko MS 39339 | |
| (662) 803-1254 | |
| (662) 289-1010 |
| Full Name | Imani Community Center |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 207 Poplar St, Kosciusko, Mississippi |
| Authorized Official Name and Position | Allie G Ndiaye (REGISTERED NURSE) |
| Authorized Official Contact | 6628031254 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imani Community Center 207 Poplar St Kosciusko MS 39090-4409 Ph: (662) 633-1513 | Imani Community Center 207 Poplar St Kosciusko MS 39339 Ph: (662) 803-1254 |
| NPI Number | 1740650969 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 09/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740650969 | NPI | - | NPPES |
| 1457623118 | Medicaid | MS | |
| 1275977357 | Medicaid | MS | |
| 1245502962 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0050750 (Mississippi) | Primary |
| 305R00000X | Preferred Provider Organization | 08533763 (Mississippi) | Secondary |
Montfort Jones Memorial Hospital Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 Hwy 12 W, Kosciusko, MS 39090 Phone: 662-290-3304 Fax: 662-290-3302 | |
Imani Community Outreach Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 E Jefferson St, Kosciusko, MS 39090 Phone: 662-289-7676 | |
Huntington House Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 N Wells St, Suite A, Kosciusko, MS 39090 Phone: 662-792-2160 | |
Brighter Horizon Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 N Wells St, Ste-a, Kosciusko, MS 39090 Phone: 662-792-2160 Fax: 662-792-4209 |