Healthcare Provider Details

I. General information

NPI: 1013225663
Provider Name (Legal Business Name): JEMECIA N. CALVIN MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W SUNFLOWER RD EWING HALL ROOM 338-DELTA STATE UNIVERSITY
CLEVELAND MS
38733-0001
US

IV. Provider business mailing address

1003 W SUNFLOWER RD DSU BOX 2211
CLEVELAND MS
38733-0001
US

V. Phone/Fax

Practice location:
  • Phone: 662-721-6756
  • Fax:
Mailing address:
  • Phone: 662-846-4364
  • Fax: 662-846-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: