Porosha Gaines, IDD WAIVER SERVICES
NPI #1386369726 in Ellisville, Mississippi
Provider Information
- NPI Number
- 1386369726
- Entity Type
- Individual
- Name
- Porosha Gaines, IDD WAIVER SERVICES
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Day Training/Habilitation Specialist
- Credential
- IDD WAIVER SERVICES
- Enumeration Date
- Oct 7, 2022
- Last Updated
- Oct 7, 2022
Practice Location
- Address
- 106 MIZE ST APT 26
- City
- Ellisville
- State
- Mississippi
- ZIP Code
- 39437-2067
- Phone
- (601) 800-8564
Specialties & Taxonomy Codes
| Specialty |
|---|
| Day Training/Habilitation Specialist |
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