Individual
HAVEN E OVERSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
77 SAINT ANNES DR, HATTIESBURG, MS 39401-8252
(601) 447-4658
Mailing address
4229 U S HIGHWAY 11, HATTIESBURG, MS 39402-8024
(601) 447-4658
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21-192155
MS
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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