Provider Demographics
NPI:1326374968
Name:MYERS, CHARISSE N (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:N
Last Name:MYERS
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 1:664 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9455
Mailing Address - Country:US
Mailing Address - Phone:601-845-0501
Mailing Address - Fax:
Practice Address - Street 1:664 SOUTHERN OAKS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9455
Practice Address - Country:US
Practice Address - Phone:601-845-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC59351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical