Individual
DR. GWENDOLYN SPENCER PRATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, MSW, LCSW
Contact information
Practice address
1134 WINTER ST, JACKSON, MS 39204-2841
(601) 948-5572
Mailing address
1134 WINTER ST, JACKSON, MS 39204-2841
(601) 948-5572
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C0999
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0999
MISSISSIPPI STATE BOARD OF EXAMINERS
MS
Enumeration date
02/11/2021
Last updated
02/11/2021
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