Healthcare Provider Details

I. General information

NPI: 1396395729
Provider Name (Legal Business Name): LASHUNN PATRICE QAASIM LPC-IT,CSAC,CS-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LASHUNN PATRICE WINDOM

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 S 108TH ST
WEST ALLIS WI
53227-3224
US

IV. Provider business mailing address

4651 N 46TH ST
MILWAUKEE WI
53218-5210
US

V. Phone/Fax

Practice location:
  • Phone: 414-885-3525
  • Fax:
Mailing address:
  • Phone: 414-588-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3215-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16605-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: