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General NPI Number Information
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NPI Number | 1306572235
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Entity Type | Organization
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Legal Business Name | FPC INTENSIVE OUTPATIENT PROGRAM
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 210 E MAIN ST STE 2C
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City | TUPELO
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State | MS
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Zip | 38804-4017
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Country | US
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Telephone | 662-760-0052
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Fax | 662-495-4080
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Provider Business Mailing Address
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Address Line | 210 E MAIN ST STE 2C
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City | TUPELO
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State | MS
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Zip | 38804-4017
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Country | US
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Telephone | 662-760-0052
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Fax | 662-495-4080
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MADISON MICHELLE ASHBY
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Credential |
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Telephone | 662-871-6657
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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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