Provider Demographics
NPI:1063226678
Name:VICKSBURG CENTER FOR EXCEPTIONAL CHILDREN
Entity type:Organization
Organization Name:VICKSBURG CENTER FOR EXCEPTIONAL CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:601-218-5497
Mailing Address - Street 1:107 HERROD ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5533
Mailing Address - Country:US
Mailing Address - Phone:601-218-5497
Mailing Address - Fax:
Practice Address - Street 1:107 HERROD ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5533
Practice Address - Country:US
Practice Address - Phone:601-218-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty