Individual
JENNIFER MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
217 DEWEY ST, COLUMBIA, MS 39429-2751
(601) 736-6799
(601) 736-4809
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3391
MS
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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