Organization
ALLURING GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA SHUNTRELL JORDAN PCSSS (COMMUNITY SUPPORT SPECIALIST)
(601) 529-0910
Entity
Organization
Contact information
Practice address
2501 W 7TH ST, APT 806, HATTIESBURG, MS 39401-3244
(601) 529-0910
Mailing address
2501 W 7TH ST, APT 806, HATTIESBURG, MS 39401-3244
(601) 529-0910
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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