MEDICARE: MRS. MAE GRACE ARRINGTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	AD89-004A	MS
2	1041C0700X	Clinical Social Worker	C6662	MS

General Provider Information

NPI Number	:	1356757678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAE GRACE ARRINGTON LCSW

Provider Business Mailing Address
First Line	:	4579 S EASON BLVD
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6539
Country	:	US
Telephone Number	:	662-377-3161
Fax Number	:	662-377-7595

Provider Business Practice Location Address
First Line	:	4428 S EASON BLVD STE B
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6506
Country	:	US
Telephone Number	:	662-234-7601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	08/18/2020

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