Organization
CENTRAL MISSISSIPPI PREVENTION SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH DANIEL JOHNSON (EXECUTIVE DIRECTOR)
(601) 631-0102
Entity
Organization
Contact information
Practice address
1911 MISSION 66 STE B, VICKSBURG, MS 39180-3762
(601) 631-0102
(601) 631-0131
Mailing address
1911 MISSION 66 STE B, VICKSBURG, MS 39180-3762
(601) 631-0102
(601) 631-0131
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C1126
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00535256
—
MS
Enumeration date
02/11/2008
Last updated
02/11/2008
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