Individual
JOHN DAVID HARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-I, ICADC
Contact information
Practice address
3901 CHICOT ST, PASCAGOULA, MS 39581-4320
(228) 762-3221
(228) 762-3202
Mailing address
2033 BASS DR, VANCLEAVE, MS 39565-8491
(228) 218-4926
(228) 762-3202
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AD10-034H
MS
171M00000X
Case Manager/Care Coordinator
AD10-034H
MS
251B00000X
Case Management Agency
AD10-034H
MS
251S00000X
Community/Behavioral Health Agency
AD10-034H
MS
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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