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General NPI Number Information
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NPI Number | 1003757675
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Entity Type | Organization
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Legal Business Name | JACKSON COMPREHENSION TREATMENT CENTER
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 1935 LAKELAND DR STE 900
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City | JACKSON
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State | MS
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Zip | 39216-5028
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Country | US
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Telephone | 601-718-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 W NORTHSIDE DR LOT 17
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City | CLINTON
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State | MS
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Zip | 39056-3353
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Country | US
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Telephone | 601-926-0569
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Fax |
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Authorized Official
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Title or Position | 3C
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Name | MR. DERRICK DEWAYNER DAVIS
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Credential | MSW
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Telephone | 601-718-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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