Organization
FPC INTENSIVE OUTPATIENT PROGRAM
Active
Parent organization
FAIR PARK COUNSELING PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIR PARK COUNSELING PLLC
Authorized official
MADISON MICHELLE ASHBY (ADMINISTRATIVE ASSISTANT)
(662) 871-6657
Entity
Organization
Contact information
Practice address
210 E MAIN ST STE 2C, TUPELO, MS 38804-4017
(662) 760-0052
(662) 495-4080
Mailing address
210 E MAIN ST STE 2C, TUPELO, MS 38804-4017
(662) 760-0052
(662) 495-4080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/25/2022
Last updated
07/25/2022
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