Healthcare Provider Details

I. General information

NPI: 1013756733
Provider Name (Legal Business Name): BRITTANY DEANNA DUCKSWORTH CMHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HIGHWAY 80 W STE R
CLINTON MS
39056-4108
US

IV. Provider business mailing address

194 SANATORIUM RD
MENDENHALL MS
39114-5444
US

V. Phone/Fax

Practice location:
  • Phone: 601-473-2106
  • Fax: 601-473-2150
Mailing address:
  • Phone: 601-695-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5616
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: