Provider Demographics
NPI:1326388562
Name:MISSISSIPPI COUNSELING CENTER
Entity Type:Organization
Organization Name:MISSISSIPPI COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:THERESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-988-5112
Mailing Address - Street 1:2460 TERRY RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-5767
Mailing Address - Country:US
Mailing Address - Phone:769-524-4605
Mailing Address - Fax:769-524-4610
Practice Address - Street 1:2460 TERRY RD
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-5767
Practice Address - Country:US
Practice Address - Phone:769-524-4605
Practice Address - Fax:769-524-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty