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General NPI Number Information
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NPI Number | 1780978247
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Entity Type | Individual
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Provider Name | MARTHA MCNEESE ROSADO LPC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 11 NORTHTOWN DR SUITE 205 D
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City | JACKSON
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State | MS
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Zip | 39211-3699
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Country | US
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Telephone | 601-977-9101
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Fax | 601-977-9188
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Provider Business Mailing Address
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Address Line | 203 HUNTERS RIDGE DR
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City | CLINTON
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State | MS
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Zip | 39056-9479
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Country | US
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Telephone | 601-434-1155
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Fax | 601-977-9188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1457
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License Number State | MS
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