25D2239508 CLIA NUMBER - DESOTO WELLNESS CLINIC

Laboratory Demographics

  • CLIA Code: 25D2239508
  • Facility Name: DESOTO WELLNESS CLINIC
  • Facility Address: 8829 CENTRE ST STE 100
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 470-6169
  • Facility Type: Other - INTENSIVE OP TREATMENT PR
  • Facility Type: Waiver
  • Lab Director: DR. CEDRIC EDWARDS
  • NPI Number: 1750051173
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 25D2239508
LAB Type Other - INTENSIVE OP TREATMENT PR
Facility Name DESOTO WELLNESS CLINIC
Street 8829 CENTRE ST STE 100
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 470-6169
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2023
Certificate Expiration Date 10/11/2025
Facility Type Other - INTENSIVE OP TREATMENT PR
Lab Director DR. CEDRIC EDWARDS

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This page was last updated on: 9/29/2025