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General NPI Number Information
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NPI Number | 1720804354
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE CONNECTIONS COMMUNITY SERVICES
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 4780 155 N STE 116 202048
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 619-722-8148
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 155 N STE 116 202048
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 619-722-8148
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | WINFRED ALARCON
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Credential | LMFT
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Telephone | 619-722-8148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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