Most Relevant Information
Provider Data
| NPI Number: | 1003393265 |
| Provider Name: | DIANE LOIS SANFORD |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/20/2018 |
| Last Updated: | 07/20/2018 |
Provider Practice Location
860 E RIVER PL STE 100
JACKSON
MS
392023442
Practice Location Phone/Fax
| Phone: | 7692515550 |
| Fax: |
Provider Mailing Location
860 E RIVER PL STE 100
JACKSON
MS
392023442
Provider Mailing Phone/Fax
| Phone: | 7692515550 |
| Fax: |