Provider Demographics
NPI:1477169423
Name:HAMPTON, CHIQUITA MINOR
Entity Type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:MINOR
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 EXCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4818
Mailing Address - Country:US
Mailing Address - Phone:601-940-8083
Mailing Address - Fax:
Practice Address - Street 1:3433 EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4818
Practice Address - Country:US
Practice Address - Phone:601-940-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor