Willie Andrew Pole Jr., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C7780 Issued in MS

Practice address

1502 S Colorado St
Greenville, MS 38703-7219

Phone

(662) 332-9872

NPI assigned

Jul 19, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1376196238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 FAIRGROUNDS RD APT I2",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037839",
            "telephone_number": "662-592-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037219",
            "telephone_number": "662-332-9872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLE",
        "first_name": "WILLIE",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C7780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Greenville, MS
• Providers in Greenville, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.