Individual
MYRTIS M TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 684-2173
(601) 249-4234
Mailing address
PO BOX 1376, WOODVILLE, MS 39669-1376
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
W2806
MS
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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