Individual
MS. ASYEONA AZARIA ALYSS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4229 U S HIGHWAY 11, HATTIESBURG, MS 39402-8024
(601) 447-4658
Mailing address
2398 BUSH DAIRY RD, LAUREL, MS 39443-0794
(601) 335-3673
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT22242719
MS
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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