Provider Demographics
NPI:1265843155
Name:EVERETTE, PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:EVERETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:WALK-EVERETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1155 ROSENBAUM AVE
Mailing Address - Street 2:BUILDING 405, NAVAL AIR STATION
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-5062
Mailing Address - Country:US
Mailing Address - Phone:601-679-3839
Mailing Address - Fax:
Practice Address - Street 1:1155 ROSENBAUM AVE
Practice Address - Street 2:BUILDING 405, NAVAL AIR STATION
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-5062
Practice Address - Country:US
Practice Address - Phone:601-679-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC14401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical