Provider Demographics
NPI:1366886772
Name:NEW PROGRESSIONS OF MISSISSIPPI, LLC
Entity type:Organization
Organization Name:NEW PROGRESSIONS OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOVON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:336-254-6770
Mailing Address - Street 1:620 GUILFORD COLLEGE RD STE G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2027
Mailing Address - Country:US
Mailing Address - Phone:336-254-6770
Mailing Address - Fax:
Practice Address - Street 1:1490 W GOVERNMENT ST STE 7-263
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3024
Practice Address - Country:US
Practice Address - Phone:336-254-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health