Individual
PORTIA FOUCHE' MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
(601) 638-0031
Mailing address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
W7785
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841513728
—
MS
Enumeration date
03/08/2010
Last updated
08/26/2020
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