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General NPI Number Information
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NPI Number | 1831206572
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Entity Type | Organization
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Legal Business Name | DELTA COMMUNITY MENTAL HEALTH
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 1654 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3250
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Country | US
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Telephone | 662-335-5274
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Fax | 662-378-3976
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Provider Business Mailing Address
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Address Line | 1654 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3250
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Country | US
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Telephone | 662-335-5274
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Fax | 662-378-3976
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Authorized Official
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Title or Position | INTERIM DIRECTOR
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Name | DR. DOUG ALLEN COLE
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Credential |
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Telephone | 662-335-5274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 16335
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License Number State | MS
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