Provider Demographics
NPI:1184941403
Name:DYGERT, LEAH JOLLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JOLLEY
Last Name:DYGERT
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 1:5915 GETWELL RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6455
Mailing Address - Country:US
Mailing Address - Phone:662-349-2979
Mailing Address - Fax:662-349-2978
Practice Address - Street 1:5915 GETWELL RD BLDG B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6455
Practice Address - Country:US
Practice Address - Phone:662-349-2979
Practice Address - Fax:662-349-2978
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC-21341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical