Provider Demographics
NPI:1336261239
Name:BARBER, DERITHA MARBORY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DERITHA
Middle Name:MARBORY
Last Name:BARBER
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 1:4710 HIGHWAY 528
Mailing Address - Street 2:
Mailing Address - City:HEIDELBERG
Mailing Address - State:MS
Mailing Address - Zip Code:39439-4953
Mailing Address - Country:US
Mailing Address - Phone:601-787-3832
Mailing Address - Fax:
Practice Address - Street 1:2103 13TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4045
Practice Address - Country:US
Practice Address - Phone:601-482-3275
Practice Address - Fax:601-482-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5745104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker