Provider Demographics
NPI:1073606851
Name:MORGAN, VICKIE AMANDA (MS)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:AMANDA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 CHESTERVILLE RD
Mailing Address - Street 2:APT 21
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-1511
Mailing Address - Country:US
Mailing Address - Phone:662-871-9766
Mailing Address - Fax:
Practice Address - Street 1:2434 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-6416
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health