Individual
MISS RESA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, NCC, LPC
Contact information
Practice address
720 OAK GROVE RD, MANTACHIE, MS 38855-8469
(662) 687-5994
Mailing address
720 OAK GROVE RD, MANTACHIE, MS 38855-8469
(662) 687-5994
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2052
MS
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
01/11/2012
Last updated
11/28/2023
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