Individual
MADISON POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
814 W PINE ST, HATTIESBURG, MS 39401-4259
(601) 781-1661
Mailing address
5996 U S HIGHWAY 49, HATTIESBURG, MS 39401-7366
(601) 913-2554
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/14/2024
Last updated
11/14/2024
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