Healthcare Provider Details

I. General information

NPI: 1962926188
Provider Name (Legal Business Name): LASHONNA DENISE FLETCHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KIRKWOOD DR
CLINTON MS
39056-5970
US

IV. Provider business mailing address

201 KIRKWOOD DR
CLINTON MS
39056-5970
US

V. Phone/Fax

Practice location:
  • Phone: 601-913-9800
  • Fax:
Mailing address:
  • Phone: 601-913-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2200
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: