Provider Demographics
NPI:1093994246
Name:WINDHAM, ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 GALLERIA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-4385
Mailing Address - Country:US
Mailing Address - Phone:662-533-0220
Mailing Address - Fax:
Practice Address - Street 1:404 GALLERIA DR
Practice Address - Street 2:SUITE 5
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4385
Practice Address - Country:US
Practice Address - Phone:662-533-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC65511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I801624Medicare PIN
MS512I800005Medicare PIN