Individual
WILLIE EDWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 249-4228
(601) 249-4244
Mailing address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 249-4228
(601) 249-4244
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0152
MS
Other
Enumeration date
03/17/2014
Last updated
03/17/2014
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