Healthcare Provider Details

I. General information

NPI: 1043421167
Provider Name (Legal Business Name): MS. ROSALIN MARIE LANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GRANTS FERRY RD
BRANDON MS
39047-9023
US

IV. Provider business mailing address

P.O. BOX 428
SUMMIT MS
39666
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 601-730-4401
  • Fax: 833-580-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM6565
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC6565
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: