Organization
SAFE HARBOR CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN MARMALICH MD (OWNER)
(228) 200-0720
Entity
Organization
Contact information
Practice address
4013 BEATLINE RD STE A, LONG BEACH, MS 39560
(228) 200-0720
(228) 200-0383
Mailing address
4013 BEATLINE RD STE A, LONG BEACH, MS 39560-4135
(228) 200-0720
(228) 200-0383
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
C9311
MS
2084P0800X
Psychiatry Physician
Primary
25543
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04334707
—
MS
Enumeration date
07/16/2018
Last updated
08/30/2018
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