Provider Demographics
NPI:1265965818
Name:LICE CLINICS OF AMERICAN - CENTRAL MISSISSIPPI, LLC
Entity type:Organization
Organization Name:LICE CLINICS OF AMERICAN - CENTRAL MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-707-5712
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 LAKE HARBOUR DR
Practice Address - Street 2:SUITE 400
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4355
Practice Address - Country:US
Practice Address - Phone:601-707-5712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty