Organization
TIFFANY DANIELS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MARION PH.D. (OWNER)
(601) 956-4816
Entity
Organization
Contact information
Practice address
5760 I 55 N STE 450, JACKSON, MS 39211-2673
(601) 956-4816
(601) 956-4817
Mailing address
PO BOX 13509, JACKSON, MS 39236-3509
(601) 956-4816
(601) 956-4817
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
M7826
MS
Other
Enumeration date
06/24/2015
Last updated
06/24/2015
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