Rudella Davenport
Individual provider Active NPI Mental Health Counselor · Vicksburg, MS
NPI 1558045377 · NPPES record last updated Jun 12, 2023
Key facts
- NPI
- 1558045377
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 3444 Wisconsin Ave
Vicksburg, MS 39180-5331 - Phone
- (601) 638-0031
- Fax
- (601) 638-4950
- NPI assigned
- Jun 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
3444 Wisconsin Ave
Vicksburg, MS 39180-5331
Mailing address
3444 Wisconsin Ave
Vicksburg, MS 39180-5331
Phone (601) 638-0031
Other providers in Vicksburg, MS
- Dalco Enterprises Inc
- Mikki L Daniel
- Chrystal Daniels
- Kimberly Sheri Daniels
- Daniel P Dare
- Tyla Davenport
- David M Halinski MD PC
- Christie Davis
- Leslie Erin Davis
- Michael L Davis
All providers in Vicksburg, MS · Mental Health Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.