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3444 Wisconsin Ave Vicksburg MS 39180-5331 | |
| (601) 638-0031 | |
| (601) 638-4950 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3444 Wisconsin Ave, Vicksburg, Mississippi |
| Authorized Official Name and Position | Margie Morgan (RISK MGMT) |
| Authorized Official Contact | 6016380031 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3444 Wisconsin Ave Vicksburg MS 39180-5331 Ph: (601) 638-0031 | 3444 Wisconsin Ave Vicksburg MS 39180-5331 Ph: (601) 638-0031 |
| NPI Number | 1578948691 |
|---|---|
| Provider Enumeration Date | 07/30/2015 |
| Last Update Date | 07/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578948691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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