Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP2500X | Professional Counselor | 2729 | MS |
N | 101YS0200X | School Counselor | 324167 | MS |
NPI | 1003424078 |
---|---|
Provider Name | Ms. Marquita Lachette Wilson |
First Address | Choctaw, MS 39350-1009 |
Second Address | Choctaw, MS 39350-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2020 |
Last Update Date | 10/11/2021 |