Organization
DESOTO WELLNESS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CEDRIC EDWARDS MD (MEDICAL DIRECTOR)
(662) 934-8671
Entity
Organization
Contact information
Practice address
8829 CENTRE ST STE 100, SOUTHAVEN, MS 38671-2610
(662) 934-8671
Mailing address
222 SOUTHLAKES DR, GRENADA, MS 38901-8499
(662) 934-8671
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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