Healthcare Provider Details

I. General information

NPI: 1841661899
Provider Name (Legal Business Name): AUTUM N PIERCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15323 HIGHWAY 35 S
BATESVILLE MS
38606-6843
US

IV. Provider business mailing address

1955 POPPS FERRY RD APT J1050
BILOXI MS
39532-2026
US

V. Phone/Fax

Practice location:
  • Phone: 662-934-7168
  • Fax:
Mailing address:
  • Phone: 662-934-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9489
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5750C
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11132
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: