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General NPI Number Information
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NPI Number | 1902440209
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Entity Type | Organization
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Legal Business Name | SUNNYBROOK CHILDREN'S HOME, INC.
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 222 SUNNYBROOK RD
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City | RIDGELAND
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State | MS
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Zip | 39157-2205
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Country | US
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Telephone | 769-972-2934
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Fax | 601-856-6555
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Provider Business Mailing Address
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Address Line | PO BOX 4871
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City | JACKSON
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State | MS
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Zip | 39296-4871
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Country | US
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Telephone | 601-856-6555
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Fax | 601-856-6520
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | KENNETH SPANSEL
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Credential | LPC
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Telephone | 601-856-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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