Organization
SBHSN
Active
Other names
Hostpay, Kim's Opening Ears
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WINGARD-FULLER (TRANSITIONAL COACH)
(601) 316-1986
Entity
Organization
Contact information
Practice address
405 CUMBERLAND CT, MADISON, MS 39110-7375
(601) 316-1986
Mailing address
657 N OLD CANTON RD, CANTON, MS 39046-9409
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/25/2025
Last updated
03/25/2025
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