Individual
BRENDA DIANE AKPOROGUAFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
210 W JACKSON ST, RIDGELAND, MS 39157-2312
(337) 600-8623
Mailing address
2432B RIVER OAKS BLVD APT B, JACKSON, MS 39211-3602
(601) 307-9676
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1346954211
MS
225700000X
Massage Therapist
Primary
1346954211
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346954211
NPI
MS
Enumeration date
08/02/2023
Last updated
08/02/2023
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