Individual
VICKI ARLENE BLAIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1617 25TH AVE # 203, GULFPORT, MS 39501-2834
(228) 325-5855
Mailing address
PO BOX 7707, DIBERVILLE, MS 39540-7602
(228) 325-5855
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C8095
MS
1041C0700X
Clinical Social Worker
CSW.09929625
CO
Other
Enumeration date
08/20/2020
Last updated
10/12/2023
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