Organization
SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT
Active
Other names
SSIPP SELECT BASKETBALL & MENTORING PROGRAM NON PROFIT, SSiPP Select Basketball & Mentoring Non Profit
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD C BENNETT (DIRECTOR)
(662) 519-1608
Entity
Organization
Contact information
Practice address
3 NOTTINGHAM CIR, GULFPORT, MS 39503-4021
(662) 519-1608
Mailing address
3 NOTTINGHAM CIR, GULFPORT, MS 39503-4021
(662) 519-1608
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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