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General NPI Number Information
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NPI Number | 1801340799
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Entity Type | Organization
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Legal Business Name | PROVIDENCE BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 5266 OLD HIGHWAY 11 STE 50
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City | HATTIESBURG
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State | MS
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Zip | 39402-7818
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Country | US
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Telephone | 678-834-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 5737 OLD NATIONAL HWY STE 300
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City | ATLANTA
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State | GA
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Zip | 30349-3865
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Country | US
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Telephone | 678-834-7615
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. NIKKI KWONA WRIGHT
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Credential | MS
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Telephone | 678-834-7615
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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 |
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License Number State |
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