Provider Demographics
NPI:1811288533
Name:DELTA AUTUMN CONSULTING, LLC
Entity type:Organization
Organization Name:DELTA AUTUMN CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:769-610-8991
Mailing Address - Street 1:101 RICKY D BRITT SR BLVD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9103
Mailing Address - Country:US
Mailing Address - Phone:662-259-0868
Mailing Address - Fax:
Practice Address - Street 1:101 RICKY D BRITT SR BLVD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9103
Practice Address - Country:US
Practice Address - Phone:662-259-0868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty