Individual
EDIE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCMHT
Contact information
Practice address
5192 HIGHWAY 11 N, ELLISVILLE, MS 39437-5050
(601) 649-7921
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6059
MS
Other
Enumeration date
10/26/2023
Last updated
10/26/2023
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