Individual
MARY REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1000 KILN DELISLE RD UNIT D, PASS CHRISTIAN, MS 39571-9701
(228) 460-3242
Mailing address
PO BOX 6643, DIAMONDHEAD, MS 39525-6600
(228) 460-3242
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
2082
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005383056
—
MS
Enumeration date
06/29/2016
Last updated
02/07/2023
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