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General NPI Number Information
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NPI Number | 1326388562
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI COUNSELING CENTER
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 2460 TERRY RD SUITE 800
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City | JACKSON
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State | MS
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Zip | 39204-5767
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Country | US
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Telephone | 769-524-4605
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Fax | 769-524-4610
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Provider Business Mailing Address
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Address Line | 2460 TERRY RD SUITE 800
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City | JACKSON
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State | MS
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Zip | 39204-5767
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Country | US
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Telephone | 769-524-4605
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Fax | 769-524-4610
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Authorized Official
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Title or Position | CONSULTANT
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Name | THERESIA RATLIFF
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Credential | LCSW
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Telephone | 601-988-5112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M5907
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License Number State | MS
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