Healthcare Provider Details

I. General information

NPI: 1366203978
Provider Name (Legal Business Name): MENDING PIECES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E INDEPENDENCE ST
BROOKHAVEN MS
39601-3101
US

IV. Provider business mailing address

401 EITEL PL
BROOKHAVEN MS
39601-2403
US

V. Phone/Fax

Practice location:
  • Phone: 601-455-6222
  • Fax:
Mailing address:
  • Phone: 601-455-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAKESHA ROBINSON
Title or Position: OWNER
Credential: LCSW
Phone: 601-455-6222