Healthcare Provider Details

I. General information

NPI: 1124874086
Provider Name (Legal Business Name): STONE OF HOPE PSYCHIATRY & ADDICTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352C HIGHWAY 15 N
PONTOTOC MS
38863-8998
US

IV. Provider business mailing address

2352C HIGHWAY 15 N
PONTOTOC MS
38863-8998
US

V. Phone/Fax

Practice location:
  • Phone: 662-597-7977
  • Fax:
Mailing address:
  • Phone: 662-597-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY MCCORMAC
Title or Position: CEO
Credential: PMHNP-BC
Phone: 662-597-7977