Healthcare Provider Details

I. General information

NPI: 1891614350
Provider Name (Legal Business Name): LATRENDA STEPHENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 LOCUST ST
MARKS MS
38646-1913
US

IV. Provider business mailing address

1024 LOCUST ST
MARKS MS
38646-1913
US

V. Phone/Fax

Practice location:
  • Phone: 276-289-5045
  • Fax:
Mailing address:
  • Phone: 276-289-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC12059
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: