Healthcare Provider Details

I. General information

NPI: 1548758832
Provider Name (Legal Business Name): LISA ALLEGREZZA SOREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N STATE ST
JACKSON MS
39201-1108
US

IV. Provider business mailing address

431 N STATE ST
JACKSON MS
39201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 601-949-1949
  • Fax:
Mailing address:
  • Phone: 601-949-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2263
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: