Healthcare Provider Details

I. General information

NPI: 1316856081
Provider Name (Legal Business Name): CARLEE GAINEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 POPLAR SPRINGS DR STE B
MERIDIAN MS
39305-1642
US

IV. Provider business mailing address

6439 GUNTER RD
WALNUT GROVE MS
39189-5239
US

V. Phone/Fax

Practice location:
  • Phone: 769-219-7666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: