Provider Demographics
NPI:1205226016
Name:PROGRESS PLACE LLC
Entity Type:Organization
Organization Name:PROGRESS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-917-1776
Mailing Address - Street 1:5144 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-8896
Mailing Address - Country:US
Mailing Address - Phone:601-917-1776
Mailing Address - Fax:
Practice Address - Street 1:5144 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-8896
Practice Address - Country:US
Practice Address - Phone:601-917-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC48201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty