Provider Demographics
NPI:1134394943
Name:CONNER, DEVONNE ANGELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEVONNE
Middle Name:ANGELA
Last Name:CONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEVONNE
Other - Middle Name:ANGELA
Other - Last Name:FESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1507 HARDY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4978
Mailing Address - Country:US
Mailing Address - Phone:601-582-5018
Mailing Address - Fax:601-582-5018
Practice Address - Street 1:212 BROAD ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3603
Practice Address - Country:US
Practice Address - Phone:601-582-5018
Practice Address - Fax:601-582-5018
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC70651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04132761Medicaid
MS302I808865Medicare PIN