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General NPI Number Information
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NPI Number | 1972730984
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DEVELOPMENT CORPORATION, INC.
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 210 GILCHRIST ST.
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City | FAYETTE
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State | MS
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Zip | 39069-0160
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Country | US
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Telephone | 601-786-3955
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 160 210 GILCHRIST ST.
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City | FAYETTE
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State | MS
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Zip | 39069-0160
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Country | US
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Telephone | 601-786-8299
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARY T. IRVING
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Credential |
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Telephone | 601-786-3955
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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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