Individual
DONNELL NICHOLES JR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4735 OLD CANTON RD STE 111, JACKSON, MS 39211-5500
(228) 896-1128
Mailing address
126 THORNWOOD DR, CLINTON, MS 39056-6227
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/12/2024
Last updated
08/19/2024
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