Provider Demographics
NPI:1609391101
Name:CATHERINE MISITA LCSW, LLC
Entity Type:Organization
Organization Name:CATHERINE MISITA LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISITA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-870-5858
Mailing Address - Street 1:20 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-9373
Mailing Address - Country:US
Mailing Address - Phone:601-870-5858
Mailing Address - Fax:601-442-9231
Practice Address - Street 1:113 N UNION ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3331
Practice Address - Country:US
Practice Address - Phone:601-870-5858
Practice Address - Fax:601-442-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC74401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05131250Medicaid