Healthcare Provider Details

I. General information

NPI: 1639354418
Provider Name (Legal Business Name): PHYLLIS T HAMMOND MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2007
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 HART ST
CANTON MS
39046-4805
US

IV. Provider business mailing address

5440 EXECUTIVE PL STE B
JACKSON MS
39206-4145
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-9888
  • Fax: 601-859-9004
Mailing address:
  • Phone: 601-212-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC1607
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: