Provider Demographics
NPI:1184390841
Name:RUNNELS, SHEILA DAWN (MS, P-LPC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DAWN
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:MS, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4434
Mailing Address - Country:US
Mailing Address - Phone:601-674-2844
Mailing Address - Fax:
Practice Address - Street 1:341 EDGEWOOD TERRACE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-6217
Practice Address - Country:US
Practice Address - Phone:601-487-6344
Practice Address - Fax:601-398-0289
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MS3114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator