Healthcare Provider Details

I. General information

NPI: 1245873595
Provider Name (Legal Business Name): SUSAN VICKERY HERRING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N STATE ST STE 212
JACKSON MS
39202-2467
US

IV. Provider business mailing address

107 LAKEVIEW CT
MADISON MS
39110-7125
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-7398
  • Fax:
Mailing address:
  • Phone: 601-259-8424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number689
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: