Provider Demographics
NPI:1396525515
Name:RUSHING, SHANDRA HOLMES (PCCSS)
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:HOLMES
Last Name:RUSHING
Suffix:
Gender:F
Credentials:PCCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2620
Mailing Address - Country:US
Mailing Address - Phone:601-218-8232
Mailing Address - Fax:
Practice Address - Street 1:114 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5104
Practice Address - Country:US
Practice Address - Phone:601-653-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPC3599171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator