Healthcare Provider Details

I. General information

NPI: 1649703695
Provider Name (Legal Business Name): LATASHA ROBINSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/21/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BRIARWOOD DR SUITE 510
JACKSON MS
39206-3051
US

IV. Provider business mailing address

5620 GLADEWOOD DR
JACKSON MS
39211-2608
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-4816
  • Fax: 601-956-4817
Mailing address:
  • Phone: 601-966-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2938
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: