Individual
HEIDI L VINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 684-2173
(601) 249-4234
Mailing address
PO BOX 768, MCCOMB, MS 39649-0768
(601) 684-2173
(601) 249-4234
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2601
MS
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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