Individual
RONI LIZANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14231 SEAWAY RD STE 501, GULFPORT, MS 39503-4628
(228) 206-6863
Mailing address
13428 CLOVERLAND CV, GULFPORT, MS 39503-8480
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2704
MS
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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