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Organization
SOUL SURVIVORS LLC
Active
Organization
SOUL SURVIVORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYVETTA RENEE MICKELL (CEO/OWNER)
(601) 807-4715
Entity
Organization
Contact information
Practice address
109 MOUNT CARMEL DR, NATCHEZ, MS 39120-2237
(601) 807-4715
Mailing address
109 MOUNT CARMEL DR, NATCHEZ, MS 39120-2237
(601) 807-4715
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
174200000X
Meals Provider
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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