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4500 I 55 N Ste 216 Jackson MS 39211-5931 | |
| (601) 718-0328 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4500 I 55 N Ste 216, Jackson, Mississippi |
| Authorized Official Name and Position | Nicholas Lamar Tew (OWNER) |
| Authorized Official Contact | 6017180328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4500 I 55 N Ste 216 Jackson MS 39211-5931 Ph: (601) 718-0328 | 4500 I 55 N Ste 216 Jackson MS 39211-5931 Ph: (601) 718-0328 |
| NPI Number | 1326535477 |
|---|---|
| Provider Enumeration Date | 04/14/2018 |
| Last Update Date | 04/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326535477 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6882 (Mississippi) | Primary |
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