Individual
MRS. JANICE LEE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, CMHT
Contact information
Practice address
339 LEGION LN, PONTOTOC, MS 38863-8978
(662) 509-9300
(662) 509-6698
Mailing address
69 COUNTY ROAD 311, OXFORD, MS 38655-8533
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/12/2006
Last updated
07/08/2007
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