Provider Demographics
NPI:1164436838
Name:STOGNER, SYLVIA SESSIONS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:SESSIONS
Last Name:STOGNER
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 1:48 OLD SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-4977
Mailing Address - Country:US
Mailing Address - Phone:601-876-2611
Mailing Address - Fax:601-876-4379
Practice Address - Street 1:729 BEULAH AVE
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2709
Practice Address - Country:US
Practice Address - Phone:601-876-2611
Practice Address - Fax:601-876-4379
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC25891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06687044Medicaid