Provider Demographics
NPI:1396395729
Name:QAASIM, LASHUNN PATRICE (LPC-IT,SAC-IT)
Entity Type:Individual
Prefix:
First Name:LASHUNN
Middle Name:PATRICE
Last Name:QAASIM
Suffix:
Gender:F
Credentials:LPC-IT,SAC-IT
Other - Prefix:
Other - First Name:LASHUNN
Other - Middle Name:PATRICE
Other - Last Name:WINDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4651 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5210
Mailing Address - Country:US
Mailing Address - Phone:414-588-8759
Mailing Address - Fax:
Practice Address - Street 1:2814 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3224
Practice Address - Country:US
Practice Address - Phone:414-885-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3215-226101YM0800X
WI17508-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health