Provider Demographics
NPI:1669957635
Name:NEW, MIRANDA REJOICE (LMSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:REJOICE
Last Name:NEW
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 1:649 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-3230
Mailing Address - Country:US
Mailing Address - Phone:256-601-7660
Mailing Address - Fax:
Practice Address - Street 1:1121 GARDNER ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3038
Practice Address - Country:US
Practice Address - Phone:256-549-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4405G101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)