Healthcare Provider Details

I. General information

NPI: 1003757675
Provider Name (Legal Business Name): JACKSON COMPREHENSION TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 LAKELAND DR STE 900
JACKSON MS
39216-5028
US

IV. Provider business mailing address

3333 W NORTHSIDE DR LOT 17
CLINTON MS
39056-3353
US

V. Phone/Fax

Practice location:
  • Phone: 601-718-2468
  • Fax:
Mailing address:
  • Phone: 601-926-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DERRICK DEWAYNER DAVIS
Title or Position: 3C
Credential: MSW
Phone: 601-718-2468