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1301 Holly St Vicksburg MS 39180-3665 | |
| (601) 630-3362 | |
| (855) 540-0718 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1301 Holly St, Vicksburg, Mississippi |
| Authorized Official Name and Position | Linda Lee Sweezer (DIRECTOR/CEO) |
| Authorized Official Contact | 6012181322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 820364 Vicksburg MS 39182-0364 Ph: (601) 218-1322 | 1301 Holly St Vicksburg MS 39180-3665 Ph: (601) 630-3362 |
| NPI Number | 1093214751 |
|---|---|
| Provider Enumeration Date | 02/08/2018 |
| Last Update Date | 02/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093214751 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | CO962 (Mississippi) | Primary |
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