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General NPI Number Information
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NPI Number | 1932810876
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Entity Type | Organization
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Legal Business Name | DIFF3R3NT MENTALITY, LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 1415 CORPORATE SQUARE DR STE A
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City | SLIDELL
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State | LA
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Zip | 70458-3151
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Country | US
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Telephone | 601-300-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 27 TERRACE HILLS DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-7335
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Country | US
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Telephone | 601-248-5115
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MISS ASPEN J HARDGES
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Credential | LCSW
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Telephone | 601-300-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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