OrganizationActive
Life Balance Clinic LLC
NPI 1811244858 · Clinical Social Worker · Vicksburg, MS
Provider details
- NPI number
- 1811244858
- Entity type
- Organization
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Annette Bryant, Owner/Provider(601) 831-4402
- License
- C6582 (MS)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1107 Openwood St
Vicksburg, MS 39183
Phone: (601) 831-4402
Fax: (601) 206-0672
Street-level locationGet directions
Mailing address
113 Woodstone Dr
Vicksburg, MS 39183-8319
Registry dates
- Enumerated
- 2012-08-09
- Last updated
- 2018-08-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.