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General NPI Number Information
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NPI Number | 1528302452
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Entity Type | Organization
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Legal Business Name | COUNSELING AND MENTORING PROGRAM 2.0
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 2460 TERRY RD STE 1900
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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 | 601-372-3085
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Fax | 601-372-3086
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Provider Business Mailing Address
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Address Line | 2460 TERRY ROAD SUITE 1900
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City | JACKSON
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State | MS
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Zip | 39204
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Country | US
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Telephone | 601-372-3085
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Fax | 601-372-3086
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JAZMIN SHANTE LYNCH
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Credential |
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Telephone | 601-371-3085
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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 |
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License Number State |
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