Healthcare Provider Details

I. General information

NPI: 1841579331
Provider Name (Legal Business Name): GAYDEN FISHER CARPENTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 I 55 N SUITE 450
JACKSON MS
39211-2651
US

IV. Provider business mailing address

PO BOX 13509
JACKSON MS
39236-3509
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-4816
  • Fax: 601-956-4817
Mailing address:
  • Phone: 601-956-4816
  • Fax: 601-956-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC6354
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: