Healthcare Provider Details

I. General information

NPI: 1831403641
Provider Name (Legal Business Name): VIRGINIA D. PANTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINNY DOSS PANTIN LCSW

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

IV. Provider business mailing address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-2711
  • Fax: 662-756-4114
Mailing address:
  • Phone: 662-756-2711
  • Fax: 662-756-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5577
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: