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General NPI Number Information
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NPI Number | 1659140465
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Entity Type | Individual
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Provider Name | LAQUNANA WILLIAMS CISTRUNK LCSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 3502 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39213-4454
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Country | US
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Telephone | 601-362-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 MADISON ST
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City | JACKSON
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State | MS
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Zip | 39202-2725
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Country | US
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Telephone | 812-538-9088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12671-C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-11480
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 133686
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW04031
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License Number State | RI
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