Individual
TIYAHRI CHERIECE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
1619 18TH AVE, GULFPORT, MS 39501-2131
(832) 245-9910
Mailing address
PO BOX 7354, DIBERVILLE, MS 39540-7201
(832) 245-9910
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
800024708
MS
Other
Enumeration date
02/02/2017
Last updated
11/13/2020
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