Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2015-09-09
- Last updated
- 2019-10-20
Specialties
Licenses
- License MS
- C3774
Location
- Practice location
- 115 N CLEVELAND AVE
- City
- BROOKHAVEN MS
- Postal code
- 396012713
- Phone
- 601-835-3306
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.