Individual
MARISSA BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648-2711
(769) 217-2810
Mailing address
PO BOX 862, LIBERTY, MS 39645-0862
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M9969
MS
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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