Active NPI
Mia Deshawn Whiteside, LCSW
- Clinical Social Worker
- Shreveport, LA
National Provider Identifier
1477925469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 62608
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (318) 221-8411
- Fax
- (915) 742-4890
- NPI assigned
- Oct 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 62608 | TX | Primary |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
501 East Stoner Avenue
Shreveport, LA 71101
Phone (318) 221-8411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62608 | Other | TX | ASSOCIATES OF SOCIAL WORK BOARD |
Other names 1
- Ms. Mia Deshawn Whiteside
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1477925469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 EAST STONER AVENUE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71101",
"telephone_number": "318-221-8411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014243",
"telephone_number": "318-221-8411",
"fax_number": "915-742-4890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITESIDE",
"first_name": "MIA",
"middle_name": "DESHAWN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-29",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "62608",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASSOCIATES OF SOCIAL WORK BOARD",
"identifier": "62608",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MIA",
"last_name": "WHITESIDE",
"middle_name": "DESHAWN",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.