Healthcare Provider Details

I. General information

NPI: 1609767532
Provider Name (Legal Business Name): LAKITA NICOLE WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 CLUBVIEW DR 1935 LAKELAND DR SUIT 900
JACKSON MS
39209-3115
US

IV. Provider business mailing address

1935 LAKELAND DR
JACKSON MS
39216-5028
US

V. Phone/Fax

Practice location:
  • Phone: 601-540-3630
  • Fax:
Mailing address:
  • Phone: 601-589-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: