Organization
JOURNEYPURE SOUTHAVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE THOMPSON MD (MEDICAL DIRECTOR)
(662) 536-6542
Entity
Organization
Contact information
Practice address
8829 CENTRE ST, SOUTHAVEN, MS 38671-2610
(662) 536-6542
(662) 314-9689
Mailing address
8829 CENTRE ST, SOUTHAVEN, MS 38671-2610
(662) 536-6542
(662) 314-9689
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MS
Enumeration date
11/23/2016
Last updated
06/16/2020
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