Healthcare Provider Details

I. General information

NPI: 1871116111
Provider Name (Legal Business Name): HANNAH NUGENT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

745 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-850-7047
  • Fax:
Mailing address:
  • Phone: 601-850-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2886
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: