Provider Demographics
NPI:1063554665
Name:AVERA, FRANCES JANEECE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:JANEECE
Last Name:AVERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-0520
Mailing Address - Country:US
Mailing Address - Phone:601-453-5376
Mailing Address - Fax:601-581-9936
Practice Address - Street 1:5000 HIGHWAY 39 N
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1021
Practice Address - Country:US
Practice Address - Phone:601-453-5376
Practice Address - Fax:888-735-7202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC09691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I802419Medicare PIN