Healthcare Provider Details

I. General information

NPI: 1245462977
Provider Name (Legal Business Name): JUANDA CROSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANDA L CROSON LPC

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 11/01/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 WEATHERSBY RD STE 150
HATTIESBURG MS
39402-1132
US

IV. Provider business mailing address

181 N WINDRIDGE LANE APT A
PURVIS MS
39475
US

V. Phone/Fax

Practice location:
  • Phone: 504-541-4924
  • Fax:
Mailing address:
  • Phone: 504-541-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1391
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1391
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: