Healthcare Provider Details

I. General information

NPI: 1245943521
Provider Name (Legal Business Name): HEATHER BREANA NORTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 WARWICK ROAD
CLINTON MS
39056
US

IV. Provider business mailing address

408 WARWICK RD
CLINTON MS
39056-6211
US

V. Phone/Fax

Practice location:
  • Phone: 601-750-4767
  • Fax:
Mailing address:
  • Phone: 601-750-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2888
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: