| Organization Name: | MISSISSIPPI CENTER FOR AUTISM AND RELATED DEVELOPMENTAL DISABILITIES |
| NPI Number: | 1891084414 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AIMEE M TISDALE (PROGRAM DIRECTOR) |
| Mailing Address: | 4061 Suzanne Dr Suite C Diberville |
| State: | MS US |
| Postal Code: | 395403735 |
| Phone Number: | 2283964434 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2011 |
| NPI Last Update Date: | 04/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |