Provider Demographics
NPI:1376997791
Name:THE PROMISE GROUP, LLC
Entity type:Organization
Organization Name:THE PROMISE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH-CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:704-277-5227
Mailing Address - Street 1:8 PARK PL APT 347P
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1570
Mailing Address - Country:US
Mailing Address - Phone:704-277-5227
Mailing Address - Fax:
Practice Address - Street 1:8 PARK PL APT 347P
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1570
Practice Address - Country:US
Practice Address - Phone:704-277-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty