Provider Demographics
NPI:1427307057
Name:SOUTHERN FOUNDATION FOR HOMELESS CHILDREN
Entity type:Organization
Organization Name:SOUTHERN FOUNDATION FOR HOMELESS CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-328-4736
Mailing Address - Street 1:688 PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MS
Mailing Address - Zip Code:39769-6620
Mailing Address - Country:US
Mailing Address - Phone:662-328-4736
Mailing Address - Fax:
Practice Address - Street 1:688 PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MS
Practice Address - Zip Code:39769-6620
Practice Address - Country:US
Practice Address - Phone:662-328-4736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS130920217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty