Provider Demographics
NPI:1932498466
Name:RECONNAISSANCE
Entity Type:Organization
Organization Name:RECONNAISSANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:CATHERYNE
Authorized Official - Last Name:ANDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-405-0049
Mailing Address - Street 1:750 AVIGNON DR STE 5
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5157
Mailing Address - Country:US
Mailing Address - Phone:601-405-0049
Mailing Address - Fax:
Practice Address - Street 1:750 AVIGNON DR STE 5
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5157
Practice Address - Country:US
Practice Address - Phone:601-405-0049
Practice Address - Fax:601-707-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty