Healthcare Provider Details

I. General information

NPI: 1972730984
Provider Name (Legal Business Name): SOUTHWEST DEVELOPMENT CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GILCHRIST ST.
FAYETTE MS
39069-0160
US

IV. Provider business mailing address

POST OFFICE BOX 160 210 GILCHRIST ST.
FAYETTE MS
39069-0160
US

V. Phone/Fax

Practice location:
  • Phone: 601-786-3955
  • Fax:
Mailing address:
  • Phone: 601-786-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY T. IRVING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-786-3955