=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902343783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA HAWKINS KENT LSW, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2017
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 840 N OAK AVE
-----------------------------------------------------
City | RULEVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38771-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-719-3421
-----------------------------------------------------
Fax | 662-756-1687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 840 N OAK AVE
-----------------------------------------------------
City | RULEVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38771-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-719-3421
-----------------------------------------------------
Fax | 662-756-1687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2385
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------