Healthcare Provider Details

I. General information

NPI: 1750004610
Provider Name (Legal Business Name): DEBORAH JEAN UPTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 06/04/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 CHAPEL HILL RD
UTICA MS
39175-9025
US

IV. Provider business mailing address

2263 CHAPEL HILL RD
UTICA MS
39175-9025
US

V. Phone/Fax

Practice location:
  • Phone: 601-397-0499
  • Fax:
Mailing address:
  • Phone: 601-397-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC9015
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: