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General NPI Number Information
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NPI Number | 1215572102
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Entity Type | Organization
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Legal Business Name | SOLID GROUND RECOVERY LLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 126 WESTOVER DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1329
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Country | US
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Telephone | 601-336-7392
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Fax | 601-402-7941
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Provider Business Mailing Address
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Address Line | PO BOX 16688
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City | HATTIESBURG
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State | MS
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Zip | 39404-6688
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Country | US
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Telephone | 601-336-7392
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Fax | 601-402-7941
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Authorized Official
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Title or Position | CEO
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Name | CHRIS BELL
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Credential |
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Telephone | 601-336-7392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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