Organization
BEHAVIORAL HEALTH AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO FRAGA LPC (OWNER)
(601) 693-1234
Entity
Organization
Contact information
Practice address
4805 POPLAR SPRINGS DR, SUITE A, MERIDIAN, MS 39305-2625
(601) 693-1234
Mailing address
4805 POPLAR SPRINGS DR, SUITE A, MERIDIAN, MS 39305-2625
(601) 693-1234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MCLPC1329
MS
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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