Organization
MISSISSIPPI CENTER FOR AUTISM AND RELATED DEVELOPMENTAL DISABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AIMEE M TISDALE PHD (PROGRAM DIRECTOR)
(228) 806-9936
Entity
Organization
Contact information
Practice address
4061 SUZANNE DR, SUITE C, DIBERVILLE, MS 39540-3735
(228) 396-4434
Mailing address
4061 SUZANNE DR, SUITE C, DIBERVILLE, MS 39540-3735
(228) 396-4434
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TS0200X
School Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
04/04/2011
Last updated
04/04/2011
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