Individual
ALICE GATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 E SYCAMORE RD, PICAYUNE, MS 39466-2700
(601) 569-0872
Mailing address
1003 E SYCAMORE RD, PICAYUNE, MS 39466-2700
(601) 569-0872
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MS
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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