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Organization
IMANI COMMUNITY CENTER
Active
Organization
IMANI COMMUNITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALLIE G NDIAYE I ETC. (REGISTERED NURSE)
(662) 803-1254
Entity
Organization
Contact information
Practice address
207 POPLAR ST, KOSCIUSKO, MS 39339
(662) 803-1254
(662) 289-1010
Mailing address
207 POPLAR ST, KOSCIUSKO, MS 39090-4409
(662) 633-1513
(662) 289-1010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0050750
MS
305R00000X
Preferred Provider Organization
08533763
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245502962
—
MS
05
—
1275977357
—
MS
05
—
1457623118
—
MS
Enumeration date
09/30/2015
Last updated
09/30/2015
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