Healthcare Provider Details

I. General information

NPI: 1831800663
Provider Name (Legal Business Name): LANIQUE ERVIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SUTTON PL APT 1812
HORN LAKE MS
38637-1467
US

IV. Provider business mailing address

1000 SUTTON PL APT 1812
HORN LAKE MS
38637-1467
US

V. Phone/Fax

Practice location:
  • Phone: 601-941-7104
  • Fax:
Mailing address:
  • Phone: 662-985-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3415
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: