Provider Demographics
NPI:1225205933
Name:RAINEY, AUDRA TERIS (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:TERIS
Last Name:RAINEY
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:607 CORINNE ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3831
Mailing Address - Country:US
Mailing Address - Phone:601-268-8796
Mailing Address - Fax:601-336-7563
Practice Address - Street 1:607 CORINNE ST
Practice Address - Street 2:SUITE A2
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3831
Practice Address - Country:US
Practice Address - Phone:601-268-8796
Practice Address - Fax:601-336-7563
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health