Individual
TANISHA NICOLE STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
02/19/2020
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