Individual
KRISTIAN CHANNING DUMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 497-0690
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 497-0690
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OOO18214
—
MS
Enumeration date
07/30/2019
Last updated
07/30/2019
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