Individual
CHEVONNA MILLOY-BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
(601) 544-4641
(601) 584-4053
Mailing address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1051
MS
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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