Healthcare Provider Details

I. General information

NPI: 1215572102
Provider Name (Legal Business Name): SOLID GROUND RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WESTOVER DR
HATTIESBURG MS
39402-1329
US

IV. Provider business mailing address

PO BOX 16688
HATTIESBURG MS
39404-6688
US

V. Phone/Fax

Practice location:
  • Phone: 601-336-7392
  • Fax: 601-402-7941
Mailing address:
  • Phone: 601-336-7392
  • Fax: 601-402-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS BELL
Title or Position: CEO
Credential:
Phone: 601-336-7392