Individual
MICHAEL PAVLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
477 COLONEL VICKREY ROAD, VANCLEAVE, MS 39565
(228) 826-4009
Mailing address
4700 COLONEL VICKREY ROAD, VANCLEAVE, MS 39565
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
03/31/2010
Last updated
04/12/2010
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