Healthcare Provider Details

I. General information

NPI: 1255268488
Provider Name (Legal Business Name): SHAKELIA K MCLAURIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 CEDAR SPRING CIR
PEARL MS
39208-8604
US

IV. Provider business mailing address

169 CEDAR SPRING CIR
PEARL MS
39208-8604
US

V. Phone/Fax

Practice location:
  • Phone: 769-229-0356
  • Fax: 769-229-0356
Mailing address:
  • Phone: 769-229-0356
  • Fax: 769-229-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3430
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: