Individual provider · Type 1 NPI

Icerica Gardner

Mental Health Counselor · Hattiesburg, MS

NPI number 1295460509 Active

Practice location

110 Patton Ave
Hattiesburg, MS 39401-6155

Call (601) 582-1111 Map

Fax (601) 450-0765

Mailing address

PO Box 18679
Hattiesburg, MS 39404-8679

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X4967 (MS)

Mental Health Counselor: Definition to come...

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About NPI 1295460509

Icerica Gardner's National Provider Identifier is 1295460509, issued on Jul 20, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Hattiesburg, MS. The record was last updated on Jul 20, 2022.