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General NPI Number Information
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NPI Number | 1396030789
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Entity Type | Organization
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Legal Business Name | CENTRAL MS COUNSELING CENTER, INC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 5846 RIDGEWOOD RD STE D108
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City | JACKSON
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State | MS
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Zip | 39211-2646
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Country | US
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Telephone | 601-957-7497
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Fax | 601-957-9323
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Provider Business Mailing Address
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Address Line | PO BOX 11886
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City | JACKSON
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State | MS
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Zip | 39283-1886
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Country | US
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Telephone | 601-957-7497
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Fax | 601-957-9323
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LARRY MCCOY
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Credential |
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Telephone | 601-214-1497
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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 | C2868
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License Number State | MS
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