Provider Demographics
NPI:1003618620
Name:SBHSN
Entity type:Organization
Organization Name:SBHSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSITIONAL COACH
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGARD-FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-316-1986
Mailing Address - Street 1:657 N OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 CUMBERLAND CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7375
Practice Address - Country:US
Practice Address - Phone:601-316-1986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health