Individual
FONTINA COURSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2436
Mailing address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2436
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MS
Other
Enumeration date
05/26/2026
Last updated
05/26/2026
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