Healthcare Provider Details

I. General information

NPI: 1588387310
Provider Name (Legal Business Name): SHEENA BARNES CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W 7TH ST
HATTIESBURG MS
39401-2822
US

IV. Provider business mailing address

PO BOX 18679
HATTIESBURG MS
39404-8679
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-0571
  • Fax: 601-583-2822
Mailing address:
  • Phone: 601-705-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3140
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: