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General NPI Number Information
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NPI Number | 1528457801
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Entity Type | Organization
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Legal Business Name | HIS GLOBAL KINGDOM INC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 607 CORINNE ST C3
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City | HATTIESBURG
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State | MS
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Zip | 39401-3831
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Country | US
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Telephone | 601-336-9017
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Fax | 601-336-9223
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Provider Business Mailing Address
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Address Line | 607 CORINNE ST C3
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City | HATTIESBURG
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State | MS
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Zip | 39401-3831
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Country | US
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Telephone | 601-336-9017
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Fax | 601-336-9223
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Authorized Official
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Title or Position | CHRSITIAN CLINICAL COUNSELOR
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Name | MR. ANTHONY ALEXANDER FRANK
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Credential | M.A. CPC. CCC
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Telephone | 601-336-9017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6280347
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License Number State | CA
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