Individual
KRYSTAL MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1905 MISSION 66, VICKSBURG, MS 39180-3711
(601) 738-5820
Mailing address
1905 MISSION 66, VICKSBURG, MS 39180-3711
(601) 738-5820
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/16/2023
Last updated
04/14/2025
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