Individual
MRS. ISETTA BIRCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
860 E RIVER PL STE 100, JACKSON, MS 39202-3442
(769) 251-5550
Mailing address
122 DESOTO AVE, CLARKSDALE, MS 38614-4420
(662) 592-5397
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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