DESOTO WELLNESS CLINIC LLC NPI 1750051173

NPI Information

DESOTO WELLNESS CLINIC LLC is an addiction (substance use disorder) counselor in Southaven, MS. DESOTO WELLNESS CLINIC LLC NPI is 1750051173. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

8829 CENTRE ST STE 100
SOUTHAVEN, MS
ZIP 38671-610
Phone: (662) 934-8671

The provider's authorized official is Cedric Edwards .
The authorized official title is Medical Director and has the following contact phone number (662) 934-8671.

The CLIA number assigned to this NPI record is 25D2239508 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/16/2021 and was last updated on 9/16/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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