Facts
- Status
- A
- Credential
- LMSW
- Type
- Individual
- Enumeration date
- 2018-10-03
- Last updated
- 2024-10-14
Specialties
Licenses
- License MS
- M9357
Location
- Practice location
- 210 HOSPITAL CIR
- City
- CHOCTAW MS
- Postal code
- 393506781
- Phone
- 601-389-4150
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.