Individual
MR. STACY SIMS FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5 ORLEANS DR, SUITE 2, HATTIESBURG, MS 39402-8675
(601) 550-7383
Mailing address
22 BLOSSOM CIR, PURVIS, MS 39475-3585
(601) 550-7383
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0669
MS
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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