Individual
BESSIE R. FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LSW
Contact information
Practice address
1733 HIGHWAY 471, BRANDON, MS 39047-8301
(601) 825-3370
Mailing address
1733 HIGHWAY 471, BRANDON, MS 39047-8301
(601) 825-3370
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0091
MS
104100000X
Social Worker
W0242
MS
Other
Enumeration date
11/15/2017
Last updated
11/15/2017
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