Individual
MR. JAMARCUS KEON CAPTVILLE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
433 WINTER ST, LUCEDALE, MS 39452-6607
(225) 877-8566
Mailing address
950 MONTERREY BLVD, BATON ROUGE, LA 70815-1155
(225) 877-8566
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386450104
—
LA
05
—
1386450104
—
MS
Enumeration date
01/14/2025
Last updated
01/14/2025
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