Healthcare Provider Details

I. General information

NPI: 1063554665
Provider Name (Legal Business Name): FRANCES JANEECE AVERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGHWAY 39 N SUITE B
MERIDIAN MS
39301-1021
US

IV. Provider business mailing address

PO BOX 520
MARION MS
39342-0520
US

V. Phone/Fax

Practice location:
  • Phone: 601-453-5376
  • Fax: 888-735-7202
Mailing address:
  • Phone: 601-453-5376
  • Fax: 601-581-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC0969
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: