Individual
LYCEDIA GASAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1967 EMILY ST, TUPELO, MS 38804-8024
(662) 760-7963
Mailing address
1967 EMILY ST, TUPELO, MS 38804-8024
(662) 760-7963
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
010239
GA
101YP2500X
Professional Counselor
Primary
2004
MS
Other
Enumeration date
06/01/2024
Last updated
06/01/2024
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