NPI 1003618620

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Organisation Community/Behavioral Health Agency Madison, MS

Practice location

Address: 405 Cumberland CT, Madison, MS 39110-7375
Phone: (601) 316-1986
Mailing address: 657 N Old Canton Rd, Canton, MS 39046-9409

Authorised official

Name: Kimberly Wingard-Fuller
Title: Transitional Coach
Phone: (601) 316-1986

Registered specialties

Community/Behavioral Health Agency Primary

Agencies Taxonomy 251S00000X

Other Community/Behavioral Health providers in Mississippi →

Registry record

NPI: 1003618620
Entity type: Organization
NPI issued: 25 Mar 2025
Record last updated: 25 Mar 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.