Healthcare Provider Details

I. General information

NPI: 1164007704
Provider Name (Legal Business Name): LASHAUNDA SMITH LPC-S, NCC, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 05/08/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 CRANE RIDGE DR STE C
JACKSON MS
39216-4944
US

IV. Provider business mailing address

1855 CRANE RIDGE DR. SUITE C
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 769-777-0322
  • Fax:
Mailing address:
  • Phone: 769-777-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2659
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2659
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2659
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: