Individual
JO-ANNA ELIZABETH BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
204 DURDEN ST, VIDALIA, GA 30474-4608
(912) 253-6595
Mailing address
204 DURDEN ST, VIDALIA, GA 30474-4608
(912) 253-6595
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MFT002127
GA
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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