Healthcare Provider Details

I. General information

NPI: 1831665462
Provider Name (Legal Business Name): LAKELAND DRIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
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 STE C
JACKSON MS
39216-4944
US

V. Phone/Fax

Practice location:
  • Phone: 769-218-8298
  • Fax:
Mailing address:
  • Phone: 769-218-8298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY SHEREE BAILEY
Title or Position: OWNER
Credential: PH.D.
Phone: 769-218-8298