Individual
JASON POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 RIVERVIEW DR STE B, FLOWOOD, MS 39232-8924
(601) 981-2707
Mailing address
132 RIVERVIEW DR STE B, FLOWOOD, MS 39232-8924
(601) 981-2707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2335
MS
101YM0800X
Mental Health Counselor
2335
MS
101YP2500X
Professional Counselor
Primary
2335
MS
Other
Enumeration date
11/30/2018
Last updated
12/01/2020
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