Individual
DEIRDRE M DANAHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4410 BROOK DR, JACKSON, MS 39206-5932
(601) 362-8288
Mailing address
4410 BROOK DR, JACKSON, MS 39206-5932
(601) 362-8288
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
110607
MA
1041C0700X
Clinical Social Worker
C7111
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110607-SW-LICSW
DIVISION OF PROFESSIONAL LICENSURE, BOARD OF REGISTRATION OF SOCIAL WORKERS
MA
Enumeration date
09/18/2018
Last updated
09/18/2018
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