Healthcare Provider Details

I. General information

NPI: 1194329193
Provider Name (Legal Business Name): KERRI FELICIA VOGT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W PINE ST
HATTIESBURG MS
39401-3835
US

IV. Provider business mailing address

412 S 21ST AVE
HATTIESBURG MS
39401-7323
US

V. Phone/Fax

Practice location:
  • Phone: 601-402-3495
  • Fax:
Mailing address:
  • Phone: 601-402-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC8968
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC8968
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: