OrganizationActive
Ignite Clinical Wellness Group
NPI 1184305666 · Mental Health Clinic/Center (Including Community Mental Health Center) · Olive Branch, MS
Provider details
- NPI number
- 1184305666
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Derrick Roach, Chief Operations Officer(901) 859-2071
Specialties & taxonomies
Ambulatory Health Care Facilities
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Professional Counselor101YP2500X
Behavioral Health & Social Service Providers
Practice location
5600 Goodman Rd Ste G
Olive Branch, MS 38654-7002
Phone: (662) 985-4101
Fax: (662) 404-7288
Approximate (ZIP-level) locationGet directions
Mailing address
5600 Goodman Rd Ste G
Olive Branch, MS 38654-7002
Registry dates
- Enumerated
- 2023-07-27
- Last updated
- 2023-07-27
- Certified
- 2023-07-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.