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General NPI Number Information
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NPI Number | 1003618620
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Entity Type | Organization
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Legal Business Name | SBHSN
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 405 CUMBERLAND CT
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City | MADISON
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State | MS
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Zip | 39110-7375
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Country | US
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Telephone | 601-316-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 657 N OLD CANTON RD
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City | CANTON
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State | MS
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Zip | 39046-9409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TRANSITIONAL COACH
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Name | KIMBERLY WINGARD-FULLER
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Credential |
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Telephone | 601-316-1986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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