Healthcare Provider Details

I. General information

NPI: 1598752792
Provider Name (Legal Business Name): CAROL L WARREN PHD, LCSW, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 VALLEY GROVE LN
SOUTHAVEN MS
38672-9207
US

IV. Provider business mailing address

9160 VALLEY GROVE LN
SOUTHAVEN MS
38672-9207
US

V. Phone/Fax

Practice location:
  • Phone: 901-438-6038
  • Fax:
Mailing address:
  • Phone: 662-393-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number667
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number67375
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: