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General NPI Number Information
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NPI Number | 1073248795
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Entity Type | Organization
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Legal Business Name | RESTORATION ESSENCE OF A LADY SHELTER, LLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 994 BANKHEAD DR
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City | BELZONI
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State | MS
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Zip | 39038
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Country | US
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Telephone | 662-318-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CAMELLIA LN
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City | INDIANOLA
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State | MS
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Zip | 38751-2604
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Country | US
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Telephone | 662-303-1800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAKENDRA AYANA WILSON
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Credential |
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Telephone | 662-303-1800
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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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