Provider Demographics
NPI:1285439778
Name:CAIN, CONTESSA LATTIMORE (CSW)
Entity type:Individual
Prefix:
First Name:CONTESSA
Middle Name:LATTIMORE
Last Name:CAIN
Suffix:
Gender:
Credentials:CSW
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 6
Mailing Address - Street 2:
Mailing Address - City:WEBB
Mailing Address - State:MS
Mailing Address - Zip Code:38966-0006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 6
Practice Address - Street 2:
Practice Address - City:WEBB
Practice Address - State:MS
Practice Address - Zip Code:38966-0006
Practice Address - Country:US
Practice Address - Phone:662-354-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW040101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty