Organization
ICONIC MIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KIMBERLY MICHELLE HORTON LCSW (OWNER)
(601) 918-8041
Entity
Organization
Contact information
Practice address
102 CRABAPPLE GRV, MADISON, MS 39110-7098
(601) 918-8041
Mailing address
1888 MAIN ST STE C, MADISON, MS 39110-6337
(601) 918-8041
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/05/2019
Last updated
01/04/2021
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