25D2155784 CLIA NUMBER - CONNECTIONS - HATTIESBURG CLINIC

Laboratory Demographics

CLIA Number: 25D2155784

Facility Name: CONNECTIONS - HATTIESBURG CLINIC

Facility Address:
102 MEDICAL PARK
HATTIESBURG, MS
ZIP 39401
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Facility Phone Number: 601 261-5159

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154410017

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	25D2155784
LAB Type	Physician Office
Facility Name	CONNECTIONS - HATTIESBURG CLINIC
Street	102 MEDICAL PARK
City	HATTIESBURG
State	MS
ZIP	39401
Phone	601 261-5159
CertificateType	4
CertificateEffectiveDate	10/4/2022
CertificateExpirationDate	10/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024