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General NPI Number Information
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NPI Number | 1528405966
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Entity Type | Organization
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Legal Business Name | SOUTHERN COUNSELING CENTER
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 428 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39206-4636
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Country | US
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Telephone | 601-238-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 5050B WAYNELAND DR
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City | JACKSON
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State | MS
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Zip | 39211-4425
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Country | US
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Telephone | 601-238-0849
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | VICTOR G EVANS
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Credential |
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Telephone | 601-238-0849
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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 | 2008000665
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License Number State | MS
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