Individual
MRS. TABATHA ENIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
399 OLD HIGHWAY 15 N, PONTOTOC, MS 38863-1111
(662) 760-2405
Mailing address
399 OLD HIGHWAY 15 N, PONTOTOC, MS 38863-1111
(662) 760-2405
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C2858
MS
Other
Enumeration date
06/17/2014
Last updated
06/17/2014
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