Provider Demographics
NPI:1720804354
Name:SUPPORTIVE CONNECTIONS COMMUNITY SERVICES
Entity type:Organization
Organization Name:SUPPORTIVE CONNECTIONS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-722-8148
Mailing Address - Street 1:4780 155 N
Mailing Address - Street 2:STE 116 202048
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:619-722-8148
Mailing Address - Fax:
Practice Address - Street 1:4780 155 N
Practice Address - Street 2:STE 116 202048
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:619-722-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty