Healthcare Provider Details

I. General information

NPI: 1326069964
Provider Name (Legal Business Name): VAGCVHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

7125 RICHMOND DR
BILOXI MS
39532-4045
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax:
Mailing address:
  • Phone: 228-392-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5595
License Number StateMS

VIII. Authorized Official

Name: DR. WILLIAM L CLAYTON
Title or Position: PSYCHIATRIST/ACTING DIRECTOR
Credential: M.D.
Phone: 228-523-5000