Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 796 | MS |
NPI | 1003119041 |
---|---|
Provider Name | Mrs. Denease Inez Bishop |
First Address | Clinton, MS 39056-3539 |
Second Address | Jackson, MS 39216-4913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 14/12/2010 |