Individual
OLIVIA CHONTE KING DEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2103 ANSLEY PARK LN, SOUTHAVEN, MS 38672-8693
(901) 240-2955
Mailing address
2103 ANSLEY PARK LN, SOUTHAVEN, MS 38672-8693
(901) 240-2955
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123
OTHER
—
Enumeration date
07/21/2021
Last updated
07/21/2021
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