Provider Demographics
NPI:1831482520
Name:DEPRIEST, NIVEA M (LMSW)
Entity Type:Individual
Prefix:
First Name:NIVEA
Middle Name:M
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4853
Mailing Address - Country:US
Mailing Address - Phone:662-841-8020
Mailing Address - Fax:662-841-8021
Practice Address - Street 1:302 S SPRING ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4853
Practice Address - Country:US
Practice Address - Phone:662-841-8020
Practice Address - Fax:662-841-8021
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC58751041C0700X
MSC59751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical