Organization
PROVIDENCE BEHAVIORAL HEALTH SERVICES
Active
Other names
Blackstone
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIKKI KWONA WRIGHT MS (DIRECTOR)
(678) 834-7615
Entity
Organization
Contact information
Practice address
5266 OLD HIGHWAY 11 STE 50, HATTIESBURG, MS 39402-7818
(678) 834-7615
Mailing address
5737 OLD NATIONAL HWY STE 300, ATLANTA, GA 30349-3865
(678) 834-7615
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/08/2016
Last updated
08/08/2016
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