Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Other names
St. Dominic Psychiatric Associates, Behavioral Health Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, ST THOMAS HALL, JACKSON, MS 39216-4606
(601) 200-3110
(601) 200-3109
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-3100
(601) 200-8846
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00784213
—
MS
Enumeration date
12/19/2006
Last updated
08/11/2021
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