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Contact Information

THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE
1107 B OPENWOOD ST.
VICKSBURG, MS39183
 Phone: 601-831-4402
 Fax: 601-262-7226
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for THE LIFE BALANCE CLINIC BEHAVIORAL HEALTH SERVICE · (Female)

NPI # 1649566894
Status Active
Credentials
Entity Individual
Enumeration date 06/27/2011
Last updated 06/27/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # C6582
  • MS Medicaid 08000025
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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