Individual
JAMIE JUANICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4905 TELEPHONE RD, PASCAGOULA, MS 39567-1823
(228) 382-9005
Mailing address
16307 PEAPATCH RD APT B, BILOXI, MS 39532-9193
(228) 861-3420
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
12/07/2020
Last updated
12/07/2020
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