Provider Demographics
NPI:1962012468
Name:WUICHET, DEBRA DIANN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANN
Last Name:WUICHET
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 1:503 MAURY CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4109
Mailing Address - Country:US
Mailing Address - Phone:662-231-0310
Mailing Address - Fax:
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:662-205-0098
Practice Address - Fax:662-495-4079
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QR0405X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical