Individual
EVELYN O MADIEBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMHT
Contact information
Practice address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 825-8800
(601) 824-0349
Mailing address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 825-8800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CMHT1639
MS
Other
Enumeration date
03/19/2021
Last updated
03/19/2021
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