Individual
MS. SAMONIA LYNN ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1414 CHERRY ST, VICKSBURG, MS 39180-3218
(601) 636-5703
(601) 636-5739
Mailing address
1414 CHERRY ST, VICKSBURG, MS 39180-3218
(601) 636-5703
(601) 636-5739
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1046
MS
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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