Provider Demographics
NPI:1083945794
Name:KIDD, ADRIANE DORSEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:DORSEY
Last Name:KIDD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 EXECUTIVE PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4145
Mailing Address - Country:US
Mailing Address - Phone:601-259-8993
Mailing Address - Fax:
Practice Address - Street 1:5440 EXECUTIVE PL
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4145
Practice Address - Country:US
Practice Address - Phone:601-259-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC10781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical