Provider Demographics
NPI:1164785689
Name:MORRIS, SHONTIA VASH'E (LPC)
Entity Type:Individual
Prefix:
First Name:SHONTIA
Middle Name:VASH'E
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHONTIA
Other - Middle Name:VASH'E
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5936 KRISTEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2835
Mailing Address - Country:US
Mailing Address - Phone:601-613-7569
Mailing Address - Fax:
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-613-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1328101YP2500X
MS198544101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool